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How to protect both health and food system sustainability? A holistic 'global health'-based approach via the 3V rule proposal
Abstract
Objective: To define a generic diet to protect human health and food system sustainability based on three dimensions: animal/plant ratio, degree of food processing, and food diversity.
Design/Setting: The percentages of maximum animal and ultra-processed calories were evaluated from scientific papers (Web of Science database) and reports (websites of international scientific institutions). Then, a weekly French standard diet, including these percentages and food diversity (≥ 42 different foods), has been designed to calculate adequacy to nutrient needs.
Results: Based on traditional and scientifically-based healthy diets, and on foresight scenarios for sustainable diets at horizon 2050, a median of 15% daily animal calories intake was found to be protective towards both human health and environment. Based on epidemiological studies associating ultra-processed calorie consumption with increased overweight/obesity risk, a precautionary threshold of 15% ultra-processed calories was observed. The French diet allows addressing all nutrient needs, except vitamin D, and other nutritional indicators such as maximum salt and simple sugar consumption, ALA/LA ratio, and essential amino acids. This diet was named the “3V rule” for Végétal (Plant), Vrai (Real), and Varié (Varied, if possible organic, local and seasonal). This generic diet can adapt according to regional traditions and environmental characteristics. Excluding only one dimension of this diet leads to threaten both health and food system sustainability.
Conclusions: Tending towards a 3V-based diet, while respecting local constraints, should allow preserving human health, environment (GHGE, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions, and socioeconomics (including an alleviation of public health cost).
... If the UPF concept is holistic (Fardet & Rock, 2019), it is also necessary to have a holistic view of dietary patterns, leading to the concept of ultra-processed dietary patterns (Scrinis & Monteiro, 2022) (Figure 1); which means that a relevant research question is: what would be the maximum threshold of calories supplied daily by UPFs? In a first analysis, based on studies relating UPF consumption with weigh gain/obesity, we have suggested not to exceed 15% daily calories as a precautionary threshold (i.e., 1-2 UPFs/day) (Fardet & Rock, 2020a). Today, some doseresponse analyses have been published through notably meta-analyses (Mazloomi et al., 2022;Moradi et al., 2021Moradi et al., , 2022Suksatan et al., 2022;Yuan et al., 2023). ...
... Together, these results suggest the need to reduce not only red meat, but also UPF consumption for improving food system sustainability. We have conceptualized these observations within the framework of the 3V rule (i.e., "Vrai," "Végétal," and "Varié" in French) (Fardet & Rock, 2020a) (Figure 2). Notably, the first rule (i.e., favoring "real" and non-UPFs) emphasized that UPFs may be consumed, but not exceeding a certain daily threshold. ...
... We integrated these concerns, human health, and environmental sustainability, in the 3V rule metric (Fardet & Rock, 2020a, which includes the degree of food processing (and hence the food matrix effect) as an emerging and fundamental dimension of our dietary patterns. Without this dimension, we can recommend to revegetate our plate without real impacts on global health if it based on ultra-processed plant-based foods, often more close to edible chemistry, with potential health concerns for which we have still little hindsight (WHO, 2021). ...
The ultra‐processed food (UPF) concept first emerged 15 years ago, and is now studied worldwide in different contexts, for example, human health, food behavior, socio‐economic, food consumption, food scoring, and food system sustainability. Briefly, UPFs are defined as containing at least one marker of ultra‐processing (MUP). MUPs are (1) cosmetic additives, (2) aromas, (3) some highly processed carbohydrates, proteins, fats, and/or fiber, and (4) drastic processes directly applied to food such as extrusion cooking or puffing. The first three categories of MUPs are on the food packaging in the list of ingredients, and are extracted, then purified, from raw foods or coming from artificial syntheses, leading to a‐matrix/a‐cellular compounds. Therefore, the core paradigm to define MUP is extreme food matrix degradation, and for UPF, matrix artificialization. Besides, UPFs are more than just junk food, encompassing numerous industrialized foods, falsely presented as healthy, for example, animal‐based food analogs, but also organic, vegan, gluten‐free, micronutrient‐enriched, and/or light foods. In this way, UPFs are “high‐quality junk foods.” Otherwise, UPF being a holistic and indivisible concept by essence, we propose in this review to analyze ultra‐processing at four holistic levels corresponding to four important scientific issues: the food matrix, the dietary pattern, food system, and food scoring. We reached the main conclusion that UPFs should be first studied with a holistic and scientifically based approach, not a reductionist one. Otherwise, we take the risk of performing greenwashing and create still more new health threats at a global level.
... Therefore, these three dimensions, i.e., the vegetal/animal product ratio, the UPF percentage, and food variety in the diet, need to be considered together to achieve a healthy and sustainable dietary pattern. However, previous analyses of scenarios addressing dietary patterns and global health [19] generally considered either only one or two of these dimensions [6], and sometimes only food nutrient contents, e.g., proteins [20], but never all three dimensions at the same time. Thus, they appear insufficiently holistic and still too reductionist to reach a strong impact on global health. ...
... For this purpose, we elaborated through an empirico-inductive approach [21] based on foresight scenarios for protecting global health at horizon 2050, and also based on validated dietary patterns for preventing chronic diseases [19], a holistic and simple index to characterize the relationship between diet and global health, i.e., the 3V index for Vrai (Real, not UPFs mimicking real foods), Végétal (Vegetal) and Varié (Varied, if possible organic, local and/or seasonal) foods [19]. Within the framework of an ideal 3V index, quantitatively, worldwide, a precautionary UPFs threshold would account for no more than approximately 15% of calories (1-2 servings/day, Real metric) and animal foods (from all sources) for an optimum of approximately 15% calories (2-3 servings/day, Vegetal metric), and weekly at least 35 different real foods (among the main food groups), as previously described [19]. ...
... For this purpose, we elaborated through an empirico-inductive approach [21] based on foresight scenarios for protecting global health at horizon 2050, and also based on validated dietary patterns for preventing chronic diseases [19], a holistic and simple index to characterize the relationship between diet and global health, i.e., the 3V index for Vrai (Real, not UPFs mimicking real foods), Végétal (Vegetal) and Varié (Varied, if possible organic, local and/or seasonal) foods [19]. Within the framework of an ideal 3V index, quantitatively, worldwide, a precautionary UPFs threshold would account for no more than approximately 15% of calories (1-2 servings/day, Real metric) and animal foods (from all sources) for an optimum of approximately 15% calories (2-3 servings/day, Vegetal metric), and weekly at least 35 different real foods (among the main food groups), as previously described [19]. ...
The Indian diet is becoming westernized with a potential threat to human health. This ecological study aimed at analyzing the nutritional transition in India during the 1990-2019 period within the framework of the newly developed 3V index, considering the degree of processing starting with industrially processed foods (IPFs, i.e., the Real/’Vrai’ metric 1), plant/animal calorie ratio (i.e., the Vegetal metric 2), and diversity of food intake (i.e., the Varied metric 3). Total and food group (n = 14) caloric intakes, percentages of animal and IPF calories, adequacy to the Indian Recommended Dietary Allowances, and prevalence of chronic diseases were retrieved from web databases (e.g., OECD.Stats, Our World in Data and FAO-STAT) and Indian food composition ta-ble. The total calorie intake increased by 31% over thirty years, being mainly linked to increased consumption of dairy products and IPF, but still remains below the average recommended in-take in 2019. The IPF and animal calorie shares increased from 3.6 to 11.6% and 15.1 to 24.3%, re-spectively, while micronutrient intakes improved in 2019. In the same time, prevalence of overweight/obesity and type 2 diabetes, and cardiovascular disease mortality increased. In con-clusion, the evolution of the Indian diet deviates from metrics 1 and 2 and improves in metric 3, which may not be a sufficient metric in terms of the alleviation of chronic diseases. Therefore, while improving food diversity and replacing refined with wholegrain cereals, Indian should also curb increasing their consumption of IPF and animal calories.
... In line with Papers One, Three and Four, sustainability needs to be addressed beyond human health/nutritional needs. Fardet and Rock (2020), for example, suggested a diet that considers human health as well as the environment, small farmers, animal welfare, biodiversity, culinary traditions, and socioeconomics, while still respecting local constraints. This particular diet is based on three dimensions rather than one (nutritional): (I) animal:plant ratio, (II) degree of food processing and (III) food diversity (Fardet & Rock, 2020). ...
... Fardet and Rock (2020), for example, suggested a diet that considers human health as well as the environment, small farmers, animal welfare, biodiversity, culinary traditions, and socioeconomics, while still respecting local constraints. This particular diet is based on three dimensions rather than one (nutritional): (I) animal:plant ratio, (II) degree of food processing and (III) food diversity (Fardet & Rock, 2020). The diet is designed qualitatively as the 3V-based diet (Végétal, Vrai and Varié) to increase people's healthy life years while preserving food system sustainability (Fardet & Rock, 2020). ...
... This particular diet is based on three dimensions rather than one (nutritional): (I) animal:plant ratio, (II) degree of food processing and (III) food diversity (Fardet & Rock, 2020). The diet is designed qualitatively as the 3V-based diet (Végétal, Vrai and Varié) to increase people's healthy life years while preserving food system sustainability (Fardet & Rock, 2020). This threedimensional diet is in line with the content of this thesis, but there are additional contributions of this thesis to food system sustainability, as will be discussed in the next section. ...
The underlying assumption throughout this thesis is that the continuity of a cultivated diversity can be strengthened by investigating its sensory qualities and specifying particular culinary utilities of landraces and cultivars. How can a foodstuff’s sensory qualities and culinary utility be explored, tested, and refined together with the food industry and the public meal? This thesis aims to create a path toward sustainable gastronomy with greater sensory variation that originate from a cultivated diversity. The thesis bridges sensory science, culinary arts, and food design, using sensory descriptive methods with consumers as well as trained sensory panelists, consumer tests with different target groups, and a recipe-development process joined up with culinary arts and agriculture. The thesis is based on four papers. Paper One shows that cultivated diversity generates a range of flavors and textures to advance in food and cooking. Paper Two investigates the interacting influence of cultivar, place of cultivation, and year of harvest on the sensory quality of peas. In Paper Three, a recipe development process is modelled and applied to gray peas, showing how appealing plant-based products can be developed. Finally, Paper Four suggests that unique/novel and natural are promising terms to use for plant-based food products, both of which could be strengthened by elements of artisanal but not vegetarian associations. A cyclic investigation and the inclusive continual improvement of a foodstuff’s sensory qualities and culinary utility with purpose and target is proposed and applied in the culinary funnel model (Paper Three), and culinary action as a tool for multi-sectoral cooperation in Paper Four. Since sensory variation is necessary for gastronomic potential, it would be useful to perceive cultivated diversity as a fundamental quality in any cuisine. Who knows which species and cultivars might be favored in the light of climate change, unsustainable resource consumption, and a growing food demand?
... Recently, we created the 3 V index, where 3 V is for Vrai, Végétal, Varié (if possible, organic, local and seasonal) in French, or Real (i.e. not ultra-processed foods), Vegetal and Varied foods in English [109] (Fig. 4). The 3 V index was created to combine both the food matrix and composition but with a hierarchical application (Fig. 4). ...
... These three metrics are those that we have observed as potentially governing the diet-global health relationship [110]. Through their holistic essence, these metrics encompass all nutritional needs when following the 15% maximum and optimum daily ultra-processed (metric 1) and animal (metric 2) food calories recommendation and 2) « ComposiƟon » effect (reducƟonist food fracƟon) Fig. 4 The hierarchy of the three metrics of the 3 V index: the food matrix "governs" the metabolic fate of nutrients varying both food groups and foods among them (metric 3) [109]. If a dimension is not fully addressed, then the diet is no longer protective of global health. ...
... Although ecological studies remain approximate for evaluating calorie intake, and that they do not take into account the differences in consumption at the level of an individual or a group of individuals, this increase can be nevertheless partially attributed to the parallel important increases in the consumption of animal-based and highly industrially processed foods, the latter often being less satiating and more hyperglycaemic foods [79,[124][125][126]. This means that beyond nutrient composition alone, the quality of calories matters; we expressed this in the Real dimension of the 3 V index (Fig. 4) [109]. Notably, in whole complex and minimally processed foods, there are also synergistic and balanced effects of bioactive compounds [89] that can be lost in micronutrient-enriched ultra-processed foods and/ or nutritional supplements [97,127]. ...
Purpose
For decades, it has been customary to relate human health to the nutritional composition of foods, and from there was born food composition databases, composition labelling scores and the recommendation to eat varied foods. However, individuals can fully address their nutritional needs and become chronically ill. The nutrient balance of a food is only a small part of its overall health potential. In this paper, we discussed the proof of concept that the increased risk of chronic diseases worldwide is primarily associated with the degradation and artificialization of food matrices, rather than only their nutrient contents, based on the assumption that “food matrices govern the metabolic fate of nutrients”.
Methods
An empirico-inductive proof of concept research design has been used, based on scientific data linking the degree of food processing, food matrices and human health, notably on the glycaemic index, nutrient bioavailability, satiety potential, and synergistic effects.
Results
We postulate that if the nutrient content is insufficient to fully characterize the diet-global health relationship, one other dimensions is necessary, i.e., the food matrix through the degree of processing. Both matrix and nutrient composition dimensions have been included under the new concept of the 3V index for Real (Vrai), Vegetal (Végétal), and Varied (Varié) foods. The Real metric, reflecting the integrity of the initial food matrix, is the most important, followed by the Vegetal (nutrient origin) and the Varied (“composition” effect) metrics.
Conclusion
Concerning their effects on health, food matrix comes first, and then nutrient composition, and calorie quality matters more than calorie quantity.
... The increasing consumption of industrialized "empty" calories [16][17][18][19], reflecting a high level of UPF consumption [20], may also be accompanied by the appearance of deficiencies of fiber and micronutrients such as iron [21], iodine [22], magnesium [23], calcium [24], and vitamins B12 [25,26] and D [27]. Moreover, this typical Western diet has been repeatedly reported to be unsustainable for global health, compromising human health [28][29][30][31][32][33][34][35][36][37][38], in addition to environmental issues, animal well-being and biodiversity, socioeconomics, culinary traditions, and the disappearance of small farmers worldwide [39][40][41][42][43][44]. Furthermore, food systems overall contribute to 34% of total greenhouse gas emissions [45]. ...
... Previous works have been undertaken to identify quantifiable criteria or model future scenarios to optimize the links between diet and global health [46][47][48][49][50]. Based on published studies related to diets, human health, and food system sustainability, three inductive, generic, and interconnected dimensions were proposed to govern the diet-global health relationship worldwide, leading to the concept of the 3V index that includes the degree of food processing (Vrai/Real foods: 15% maximum UPF calories/day), the plant/animal product ratio (Végétal/Plant foods: 15% maximum animal calories/day), and food diversity (Varié/Varied foods) [40,51]. This generic index represents both qualitative and quantitative holistic metrics regarding human health and food system sustainability. ...
... The qualitative and quantitative aspects of the 3V index-based metrics have been previously thoroughly described [40,51]. To assess the evolution of plant/animal and non-UPF/UPF calorie consumption during the 1998-2015 period, INCA food categories (g/day) were converted into calories. ...
In France, the evolution of dietary pattern relative to sustainability and global health remains insufficiently studied. The objective of this study was to assess dietary changes during 1998-2015 through three generic metrics potentially related to sustainability. Food consumption data were collected from three French National Individual Study of Food Consumption surveys (INCA) for children (0-17 years) and adults (18-79 years) representative of the French population. The consumed foods were converted into plant (metric 1) and non-ultra-processed (UPF, metric 2) calories, and analyzed in meeting dietary recommended intakes (metric 3). French children and adults consumed high levels of animal and UPF calories, and nutrient deficiencies were observed in adults from the 2015 survey, e.g., fiber, EPA, DHA, magnesium, retinol, and vitamin C. In children, UPF daily calories increased from 42.8 to 45.5% and decreased in adults from 39.2 to 35.0%. In children and adults, diet revegetation was observed. While the level of physical activity decreased, overweight , obesity and type 2 diabetes prevalence increased in French adults. The French dietary pattern is not sustainable for global health unless public health policy is reinforced, with at least a twofold decrease in animal and UPF calories and improved food diversity.
... According to the EAT-Lancet Commission [15] a healthy reference diet consists mostly of vegetables, fruits, whole grains, legumes, nuts and unsaturated oils; it also includes a low to moderate amount of seafood and poultry, but excludes or includes in low quantities the following foods: red meat, processed meat, added sugar, refined grains and starchy vegetables. Fardet and Rock [17] referred that a French diet called the "3V rule" (standing for vegetable, real and varied and whenever possible organic, local and seasonal) provides all nutritional needs. Additionally, this model could be transposed to other contexts, and adapted according to regional traditions and environmental characteristics. ...
... Additionally, this model could be transposed to other contexts, and adapted according to regional traditions and environmental characteristics. However, they alert that by excluding even only one dimension, could set at risk the health as well as the sustainability of the food system [17]. Hence, the adoption of this 3V-based diet, with respect for local constraints, would preserve the human health and also the environment (greenhouse gas emissions, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions and socioeconomics (including an alleviation of public health cost) [17]. ...
... However, they alert that by excluding even only one dimension, could set at risk the health as well as the sustainability of the food system [17]. Hence, the adoption of this 3V-based diet, with respect for local constraints, would preserve the human health and also the environment (greenhouse gas emissions, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions and socioeconomics (including an alleviation of public health cost) [17]. ...
This work intended to explore some motivations that influence people's eating habits towards sustainability. This was an observational, cross-sectional study, carried out by questionnaire survey on a non-probabilistic sample of 10,067 participants from 13 countries (United States). Results indicated that people prefer fresh local foods from the season, being important because it allows transportation and storage to be reduced, which in many cases implies refrigeration systems and consequent energy expenditure. Although people avoid food waste at home, the awareness for the waste at restaurants still needs to be improved. Consumers seem to prefer foods that have been produced and packed in sustainable ways but still give importance to the package-understandable for food products. The results also indicated significant differences in the food choice motivations between groups for all sociodemographic variables tested (age, sex, marital status, education, professional area, living environment and country), but the association was high only for variable country. Additionally, a tree classification analysis allowed to identify the relative importance of the influential variables on the sustainable food choices, with country being the most important, followed by age and sex. Additionally, discriminant function analysis allowed establishing a model for the relation between country and six variables accounting for preservation of biodiversity, respect for life, save natural resources, save energy, reduce industrial Citation: Guiné, R.P.F.; Bartkiene, E.; Florença, S.G.; Djekić, I.; Bizjak, M.Č.; Tarcea, M.; Leal, M.; Ferreira, V.; Rumbak, I.; Orfanos, P.; et al. Environmental Issues as Drivers for Food Choice: Study from a Multinational Framework. Sustainability 2021, 13, 2869.
... For instance, Willett et al. (2019) examined the nutrition and environmental aspects of food systems. Fardet & Rock (2020) considered health and nutrition in a broader assessment including environmental and socio-economic factors but without quantifying the latter. Ritchie et al. (2018) introduced the concept of a "field-to-fork" assessment of nutritional intakes, proposing a food system assessment from a nutritional perspective. ...
... This is exemplified in the hotspots identified across the different supply chains such as the production of milk , butter (Flysjö, 2011), canned sardines (Almeida et al., 2015), recipes (Cambeses-Franco et al., 2023), and different dairy farms (Mazzetto et al., 2022). Furthermore, n-LCA is a tool to account for nutritional quality of food products and novel foods while doing environmental impact assessment (Fardet and Rock, 2020;Mazac et al., 2023;McAuliffe et al., 2020). One of the advantages of using LCA is its cradle-to-grave scope allowing it to account for the impacts generated from various locations. ...
Food systems are composed of interrelated activities that transform agricultural products into food. Their operations need to meet several food security, food safety, and sustainability requirements. Therefore, risk assessment of food systems must be multidisciplinary and include food safety, nutrition, environmental, economics, and social criteria. However, combining these criteria to assess multiple impacts remains a challenge in complex and multi-stakeholder systems. Until now, only a few holistic assessments, whether domain-oriented or generic and with different levels of quantification, have covered all criteria and the whole food systems. We reviewed and presented the various assessment methods and their applications in food systems, highlighting their advantages and disadvantages. Recommendations were made for a tiered approach combining different holistic assessment methods.
... Health is the foundation of sustainable development, emphasizing the interrelationship of health and sustainability [71]. A healthy and sustainable lifestyle is promoted when health awareness and sustainable consumption are interrelated [72]. Companies must create more sustainable products to reduce the pressure on consumers to change their habits. ...
... Furthermore, halal values require equitable trading practices to assist small-scale manufacturers with commodity production by paying fair prices and promoting sustainable livelihoods. Some sustainability indicators, such as food integrity, environmental friendliness, equitable trading, and animal interest, can be found in halal principles [72]. ...
The purpose of this research is to examine the impact of supply chain integration (SCI), demand for halal products (DHP), halal marketing (HM), process quality improvement (PQI), food safety concerns (FSCs), and health consciousness (HC) on sustainable product performance (SPP) in the halal food industry in Malaysia. A survey was conducted with 212 respondents from Malaysian halal-certified companies, and the partial least squares (PLS-SEM) method was used for the data analysis. The findings indicate a positive and significant link between SCPI, HC, PQI, and SPP. In contrast, the findings show no significant link between HM, FSC, and SPP. DHP was found to have a negative, non-significant association with SPP. This paper concludes by discussing the implications of the findings and opportunities for future research.
... Es loable el trabajo adelantado por Fardet & Rock quienes, con el objetivo de simplificar los mensajes relacionados con la alimentación y nutrición y para explorar sobre una perspectiva más holística de lo alimentario (12), basados en evidencia científica proponen tres reglas de oro para proteger la salud humana, el bienestar animal y el medio ambiente, dichas reglas se incluyen mutuamente y usan la nemotecnia de las 3V, por sus nombres en Frances: Vegétal (vegetal), Vrai (real) y Varié (variada) (11,19). ...
... Los autores diseñaron lo que ellos describen como una dieta genérica 3 basada en la relación alimento animal/vegetal, el grado de procesamiento de los alimentos y la diversidad de alimentos, respetando las limitaciones locales y preservando tradiciones culinarias regionales (19). ...
El patrón alimentario promovido y dominante en la actualidad, se caracteriza por una fuerte industrialización y presencia de productos comestibles ultraprocesados cuyo perfil nutricional afecta la salud, y además, genera implicaciones social, cultural, económica y ambientalmente negativas, asociadas a las formas de producción, procesamiento, distribución y consumo de estos productos, propiciando un distanciamiento entre el ser humano y el alimento, deteriorando la cultura alimentaria e invisibilizando la alimentación como hecho social. En este documento se reflexiona sobre la importancia de migrar hacia un patrón alimentario basado en alimentos reales y se esboza la alimentación real como propuesta parael análisis de los asuntos alimentarios y nutricionales. La alimentación real es una concepción vanguardista con poca teorización, podría identificarse como un patrón de alimentación que supera la visión limitada del nutricionismo, a su vez, representa unbajo impacto ambiental, es pertinente desde el punto de vista sociocultural y promueve la adopción de estilos de vida saludables
... Cependant, de meilleurs choix et transformations alimentaires pourraient aussi contribuer à diminuer cette forte empreinte carbone de l'amont. Pour répondre à ces enjeux, un changement de paradigme a été proposé, et basé sur la règle inductive, générique et holistique des 3V BLS élaborée sur la base des régimes alimentaires traditionnels protecteurs de la santé humaine et de scénarii prospectifs à l'horizon 2050 pour préserver et protéger la santé globale 4 . Cette règle rassemble trois dimensions qui gouvernent la relation alimentation-santé globale 5 Autre conséquence de cette hiérarchisation : l'effet « matrice » gouverne l'effet « composition ». ...
... On pourrait également s'interroger pourquoi la consommation de fromages est associée à des risques diminués de maladies cardiovasculaires 13 bien que riches en acides gras saturés, alors que ces derniers sont généralement considérés comme des nutriments à limiter dans les scores de compositions : effet « matrice » ou un profil plus bénéfique en acides gras saturés différent de celui rencontré dans les aliments ultratransformés ? La présente étude s'inscrit dans un projet de recherche sur la faisabilité pratique d'un régime alimentaire dérivant de la règle des 3V BLS , d'abord explorée chez les 3-10 ans 7 et les adultes 4 Figure 3. Exemple d'un menu hebdomadaire en EHPAD tendant vers les 3VBLS tout en respectant les minimas du GEMRCN des aliments vendus par les fournisseurs de restauration collective sont ultratransformés (n = 26 fournisseurs) 22 . Pour le régime EHPAD tendant vers les 3V BLS , nous avons réalisé deux types de calculs théoriques selon que les aliments étaient fournis par la restauration collective (donc 58% d'aliments ultra-transformés en moyenne) ou fournis localement et donc non ultra-transformés car préparés sur place en cuisine. ...
Face aux enjeux environnementaux, il n'est plus suffisant de manger sain pour soi, mais aussi pour protéger la santé globale (humaine et planétaire). Dans cette étude nous nous sommes focalisés sur la durabilité potentielle du régime alimentaire de la population française âgée de plus de 65 ans, et dont environ les deux-tiers sont atteints de maladies chroniques et 4,4% vivent en institutions spécialisées. Pour cette analyse, nous avons appliqué la règle nouvellement développée des 3V BLS (Végétal, Vrai, Varié, si possible Bio, Locale et/ou de Saison), qui gouverne la relation alimentation-santé globale. Elle préconise un optimum de 15% de calories animales et 15% de calories ultra-transformées par jour pour atteindre la durabilité à l'horizon 2050. Ainsi, le régime alimentaire des plus de 65 ans a été caractérisé au regard des 3V-BLS dans la population INCA3 (2014-2015) et illustré par un menu hebdomadaire en EHPAD. Puis nous avons modélisé un régime 3V-BLS en EHPAD et à domicile et discuté sa faisabilité dans le cas de 14 pathologies chroniques les plus fréquentes. Les résultats montrent que les plus de 65 ans consomment respective-ment 36 et 27% de calories animales et ultra-transformées/jr dans INCA3, et 33 et 49% dans l'exemple choisi en EHPAD. L'application du régime 3V-BLS en EHPAD est difficile dans le cadre des contraintes du GEMRCN a en produits animaux et parce que les EHPAD s'approvisionnent souvent en restauration collective avec un fort pourcentage d'aliments ultra-transformés. Cependant, à domicile il est possible de tendre vers un régime 3V-BLS pour un coût d'environ 8 euros/jour. Au final, le régime 3V-BLS serait applicable à au moins 33% de la population âgée sans maladies chroniques, et potentiellement au deux-tiers incluant certaines maladies chroniques.
... In this way, the health of these individuals in the at-risk group working the night shift will be protected while natural resources will also be protected. Sustainable nutrition models, which will become an inevitable proposal of the age by consensus, are characterized by prominently featuring substantial quantities of plantbased foods, including vegetables, fruits, seeds, nuts, legumes, and whole grains, while incorporating only moderate-to-minimal amounts of animal-based products, such as meat, poultry, seafood, eggs, and dairy [15,[32][33][34][35]. Considering the foods included in sustainable nutrition recommendations, it appears that they meet the dietary approaches recommended to improve health in individuals working night shifts. ...
This study aimed to investigate the change in diet quality in addition to dietary adherence to the planetary health diet during night shifts in healthcare workers. This observational follow-up study involved 450 healthcare workers working night shifts (327 females, 123 males). A survey form requesting sociodemographic information (gender, age, marital status), job title, sleeping duration during the night shift, 24 h dietary records for pre-night-shift, during night shift, and post-night-shift, and anthropometric measurements (body weight and height) was applied. The scores of the Planetary Health Diet Index (PHDI) and the Healthy Eating Index 2020 (HEI-2020) were calculated according to the dietary records. The total HEI-2020 and PHDI scores decreased significantly (p < 0.05) during the night shift (44.0 ± 8.8 and 48.3 ± 13.2, respectively) compared to pre-night-shift (46.1 ± 9.2 and 51.9 ± 13.4, respectively) and increased post-night-shift (44.7 ± 9.9 and 50.6 ± 14.9, respectively), with no statistically significant difference between pre- and post-night-shift. There was a significant main effect of night shift working on total PHDI (F(896, 2) = 8.208, p < 0.001, ηp² = 0.018) and HEI-2020 scores (F(894, 2) = 6.277, p = 0.002, ηp² = 0.014). Despite healthcare workers’ knowledge of health factors, night shifts lead to poor dietary choices. To improve diet quality and sustainability, it is crucial to enhance access to healthy food options in their work environment.
... Strategies to achieve a sustainable food system capable of feeding close to 10 billion people by 2050 should include the adoption of healthy and sustainable diets, the development of innovative technology for sustainable food production, and the reduction of food loss and waste (9). Sustainability should be considered as a long-term part of the assessment of food literacy and food security. ...
Aim:
This study aimed to evaluate the impact of food literacy and sustainable consumption behaviors on nutritional status during the pandemic in Turkey.
Methods:
The study was conducted between May and July 2021 with a questionnaire delivered in a digital environment (social media, Twitter/Facebook/Instagram) to 200 volunteer adults aged 20-65. With this questionnaire form, sociodemographic characteristics, general information, and consumer behaviors of the individuals were obtained. Anthropometric measurements (height, body weight, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, and waist/height ratio) of the individuals were recorded online as self-report. The Self Perceived Food Literacy (SPFL) Scale was administered to measure nutritional literacy levels. To measure the sustainable consumption behaviors of the individuals, the Sustainable Consumption Behavior (SCB) Scale was administered.
Results:
We found that 87.2% of women and 40% of men had heard of sustainable nutrition before (p < 0.001). The mean total score of SCB was statistically significantly higher in women than in men (3.1 ± 0.48 in women, 2.9 ± 0.69 in men, p < 0.05). The mean score of SPFL was 3.31 ± 0.275 in women, while it was 3.05 ± 0.395 in men. There was a statistically significant relationship between SPFL mean scores and gender (p < 0.05).
Conclusion:
There was a statistically significant negative relationship between SPFL score and BMI, body weight, and waist/hip ratio. There was a statistically significant negative relationship between the SCB and waist/hip ratio. Food literacy and sustainable consumption behaviors are associated with anthropometric measurements. Sustainable nutrition, sustainable consumption behaviors, and food literacy should be considered as a whole. Trainings should be increased to raise awareness of individuals about food literacy.
... Un-processed ( Higher adherence to the MedDiet was found in the current study to be a strategy for reducing UPF consumption (García et al., 2023). This is explained by the defining fact that MedDiet, beyond nutritional content considerations commented elsewhere (Fardet and Rock, 2020a), is made up of mainly fresh products, with a low level of processing. A linear association of MedDiet with a sustainability score had already been described considering the same four environmental parameters in the current study (Grosso et al., 2020), demonstrating that a higher MedDiet adherence was specifically related with lower GHGs (García et al., 2023;Grosso et al., 2020). ...
Background:
Dietary patterns can produce an environmental impact. Changes in people's diet, such as the increased consumption of ultra-processed food (UPF) can not only influence human health but also environment sustainability.
Objectives:
Assessment of the impact of 2-year changes in UPF consumption on greenhouse gas emissions and water, energy and land use.
Design:
A 2-year longitudinal study after a dietary intervention including 5879 participants from a Southern European population between the ages of 55-75 years with metabolic syndrome.
Methods:
Food intake was assessed using a validated 143-item food frequency questionnaire, which allowed classifying foods according to the NOVA system. In addition, sociodemographic data, Mediterranean diet adherence, and physical activity were obtained from validated questionnaires. Greenhouse gas emissions, water, energy and land use were calculated by means of the Agribalyse® 3.0.1 database of environmental impact indicators for food items. Changes in UPF consumption during a 2-year period were analyzed. Statistical analyses were conducted using computed General Linear Models.
Results:
Participants with major reductions in their UPF consumption reduced their impact by -0.6 kg of CO2eq and -5.3 MJ of energy. Water use was the only factor that increased as the percentage of UPF was reduced.
Conclusions:
Low consumption of ultra-processed foods may contribute to environmental sustainability. The processing level of the consumed food should be considered not only for nutritional advice on health but also for environmental protection.
Trial registration:
ISRCTN, ISRCTN89898870. Registered 05 September 2013, http://www.isrctn.com/ISRCTN89898870.
... Ultra-processed foods are industrial foods that are highly manipulated and contain more than five ingredients and/or chemicals, and in which the matrix and nutrient are is degraded, as well as their overall quality (Fardet & Rock, 2022). These foods greatly promote the development of chronic diseases (Askari et al., 2020;Pagliai et al., 2020), when, in contrast, a diet that consists mainly of 'real' (that aren't ultra-processed), varied and plant-based foods helps prevent them (Fardet & Rock, 2020). ...
The diet of individuals is influenced by social and cultural factors. Children’s food tastes and representations, being principally transmitted by their parents, are likely to depend on their social backgrounds. As it is known that parents’ feeding strategies and food education differ depending on their social positions, this study aimed at examining how food representations and tastes vary among children. A qualitative sociological study, based on semi-structured interviews, was conducted with forty children, aged from 9 years to 11 years, within four French elementary schools. Results showed that children from disadvantaged social backgrounds mentioned less foods, seemed to have a less varied diet, to consume less vegetables, and to enjoy eating ultra-processed foods more than other children. Different food habitus were found, that can be put into perspective with Bourdieu’s distinction theory, including different preoccupations regarding health and necessity among social groups. Disparities in children food habitus could be theoretically linked with observed and growing social inequalities in health, when taking into consideration the potential practises that these habitus imply, and their probable effects on health. Participative food education classes at school could be a relevant perspective, although some concerns and limits must be addressed.
... Il est entre autres connu que les antioxydants, largement présents dans les fruits et légumes frais 2 , aident à prévenir le développement de cancers en luttant contre les radicaux libres et le stress oxydant, en préservant ainsi la santé des cellules et du corps dans son ensemble. Il semble également intéressant de constater que la dimension multifactorielle des causes du développement des maladies chroniques, ainsi que la relation entre environnement et santé, correspondent aussi aux capacités de l'alimentation pour leur prévention (Fardet et Rock, 2014), Nous savons par exemple qu'en adoptant, à l'échelle globale, une alimentation majoritairement végétale, vraie (c'est-àdire une alimentation composée le moins possible d'aliments « ultra-transformés ») et variée (si possible bio, locale et de saison), il serait alors possible de protéger la santé humaine, aussi bien que celle de l'environnement, des animaux et de la biosphère (Fardet et Rock, 2020). ...
Face à la croissante prévalence des maladies chroniques (phénomène aussi appelé « transition épidémiologique »), notre santé est intrinsèquement liée à notre relation avec l’environnement. Elle ne dépend plus seulement de soins, mais aussi et surtout de sa prévention. L’alimentation est une interaction quotidienne avec l’environnement, elle peut soit contribuer à prévenir des maladies chroniques, soit les favoriser. Si s’alimenter représente un pouvoir d’agir au quotidien sur notre santé, ce pouvoir se retrouve contraint par des facteurs socioéconomiques, ainsi que largement influencé par des facteurs culturels. Les plus précaires sont les plus affectés par les maladies chroniques, tout en ayant une alimentation susceptible de contribuer à leur développement. La sociologie de l’alimentation peut aider à élaborer une prévention adaptée, via l’étude des représentations alimentaires de ces populations.
... Overall, our findings emphasize the importance of considering more than just a single or a combination of nutrients for the prevention of CVD. This thinking is closely allied with the "3V" rule of Fardet and Rock, emphasizing Végétal (plant), Vrai (real) and Varié (varied, if possible organic, local and seasonal) aspects of food choice [32]. ...
To better understand nutrition paradigm shift from nutrients to foods and dietary patterns, we compared associations of a nutrient-based blood cholesterol-lowering diet vs. a food-based plant-centered diet with risk of coronary heart disease (CHD) and stroke. Participants were 4701 adults aged 18–30 years and free of cardiovascular disease at baseline, followed for clinical events from 1985 and 86 to 2018. A plant-centered diet was represented by higher A Priori Diet Quality Score (APDQS). A blood cholesterol-lowering diet was represented by lower Keys Score. Proportional hazards regression was used to calculate hazard ratios (HR). Higher APDQS showed a nutrient-dense composition that is low in saturated fat but high in fiber, vitamins and minerals. Keys Score and APDQS changes were each inversely associated with concurrent plasma low-density lipoprotein cholesterol (LDL-C) change. Over follow-up, 116 CHD and 80 stroke events occurred. LDL-C predicted CHD, but not stroke. APDQS, but not Keys Score, predicted lower risk of CHD and of stroke. Adjusted HRs (95% CIs) for each 1-SD higher APDQS were 0.73 (0.55–0.96) for CHD and 0.70 (0.50–0.99) for stroke. Neither low dietary fat nor low dietary carbohydrate predicted these events. Our findings support the ongoing shift in diet messages for cardiovascular prevention.
... Scientific data relating UPFs to increased risks of chronic diseases (Askari et al. 2020;FAO et al. 2019;Lane et al. 2021;Pagliai et al. 2021) and degradation of food system sustainability leads to add a third dimension to the "plant/animal ratio" and "food diversity" dimensions, i.e., that of the degree of food processing Fardet and Rock 2018;Ministry of Health of Brazil 2014;Seferidi et al. 2020). These empiric observations from published data resulted in what we have defined as the 3 V rule, referring to Plant ("Végétal"), Real ("Vrai", or non-UPF, as opposed to UPFs), and Varied ("Varié", if possible organic, local and seasonal) (Figure 4) (Fardet and Rock 2020b). The 3 V rule started with the assumption that human and food system health are compatible, and thereafter try to identify -according to an inductive method -generic rules that governs the diet-global health relationship. ...
Scientific research generally follows two main methods: empirico-inductive (EI), gathering scattered, real-world qualitative/quantitative data to elaborate holistic theories, and the hypothetico-deductive (HD) approach, testing the validity of hypothesized theory in specific conditions, generally according to reductionist methodologies or designs, with the risk of over simplifying the initial complexity empirically perceived in its holistic view. However, in current food and nutrition research, new hypotheses are often elaborated from reductionist data obtained with the HD approach, and aggregated to form (ultra)reductionist theories, with no application of EI observations, limiting the applicability of these hypotheses in real life. This trend and the application of the EI method are illustrated as regards with the global health issue through the examples of food classifications/scoring, clinical studies, the definition of a sustainable diet, the “matrix effect”-related hypothesis, the concept of healthy core metabolism, and obesity prevention within the perspective of social sciences. To be efficient for producing food and nutritional data appropriable by the society, it finally appears that not only both approaches are necessary, starting with the EI method then the HD one, but also a back and forth between the two, this being not always realized, potentially leading to confusion and misunderstanding in society.
... Moreover, still according to these authors, only a few compounds within a class are investigated, and there are knowledge gaps on appropriate analytical methods for food analysis. The acknowledged complexity of foods (in their multiple dimensions) calls for information on multiple relationships, as the nexus between public health and the environment, or consumer preference and health [51,52,78,79]. Ocké et al. [9], besides identifying some gaps herein mentioned, also refer to the need for FDBs' adaptation to the rapidly changing food landscape and the need for their improvement and harmonization to enable comparisons of research outputs at international level. ...
Food provides humans with more than just energy and nutrients addressing both vital needs and pleasure. Food habits are determined by a wide range of factors, from sensorial stimuli to beliefs, and once commanded by local and seasonal availability, are nowadays driven by mar-keting campaigns promoting unhealthy and non-sustainable foodstuffs. Top-down and bottom-up changes are transforming food systems, driven by policies on SDGs and by consumer’s con-cerns about environmental and health impacts. Food quality, in terms of taste, safety and nutri-tional value are determined by its composition, described in food composition databases (FDB). FDB are then useful resources to agronomists, food and mechanical engineers, nutritionists, marketers and others in their efforts to address at maximum human nutrient needs. In this work we analyse some relevant food composition databases (viz. purpose, type of data, ease of access, regularity of updates), inspecting information on the health and environmental nexus, as food origin, production mode as well as nutritional quality. The usefulness and limitations of food databases are discussed in what concerns sustainable diets, food “matrix effect”, missing com-pounds, safe processing and in guiding innovation in foods, as well as in shaping consumers’ perceptions and food choices.
... Notably, excessive consumption of animal products and ultra-processed food (UPF), associated with the lack of variety in diets, may threaten human health, animal and plant biodiversity and the environment as a whole (Fardet and Rock, 2018). The qualitative 3V rule provides a simple metric for assessing the healthiness and sustainability of consumer food choices, with the three V's standing in French for 'Végétal' (plant-based), 'Vrai' ('real' foods, i.e., not ultra-processed) and 'Varié' (varied) (Fardet and Rock, 2018, 2020a, 2020b. It is based on three indicators of the relation between diet and global health: the plant/animal caloric ratio, with an optimum of ≈15% animal calories/day; the degree of processing, with a maximum of 15% ultra-processed calories/day; the diversity of the diets-if possible organic, local and seasonal. ...
In France, hypermarkets are the main shopping sites for food products. Therefore, the food-purchasing profiles of their regular customers may be a relevant indicator of the sustainability and health potentials of consumed diets. Knowing this information can be a step to address the issue of global health. The main objective of this study was to assess the sustainability and health potential of food-purchasing behaviors among regular adult customers, with or without children, of a leading French retailer. Secondarily, the cost of a sustainable food shopping cart was evaluated as regards the regular one, as calculated in this study. Purchasing receipts corresponding to 38,168 different food products were collected during one consecutive month for each four seasons in 2019 to assess compliance with a newly developed holistic indicator of food system sustainability, i.e., the 3V rule, recommending food consumption to be ‘Vegetal’/plant-based (≈15% animal calories/day), ‘Vrai’/real (max. 15% ultra-processed food calories/day, UPF) and ‘Varié’/varied. Participants were 708 regular buyers (aged ≥18 with different socio-economic profiles, with and without children) in 122 French hypermarkets. The plant rule was based on the animal and plant origin of food ingredients, including mixed products; the ‘real’ rule was evaluated with the Siga score according to the degree of processing to identify UPFs. The varied rule was defined based on a combination of food ‘categories × families’. The effect of children and season on the purchased animal and UPF calories and on the variety index was also evaluated. Multivariate and decision tree analyses were applied to compare consumers for their 3V rule profile similarities and differences, and to look for impacts of the presence or absence of children. Customers' purchases were far from the 3V rule, with a median of 41% animal and 61% UPF calories and a median variety index of 25% (compared to the consumer with the highest index set to 100%). There was no difference in purchased animal and UPF percentages neither according to seasons nor the presence of children. However, the presence of children was associated with a higher variety index (+33%, P < 0.05). Finally, the more the consumers purchased varied, the less they purchased UPFs. Compared to the average food basket, a 3V-based basket would cost 4.6% less. To make this basket accessible to everyone and to orientate consumer's purchasing behaviors toward more sustainable and healthier products, and hence food systems, hypermarkets should promote healthy eating and reassess their food offerings.
... En résumé, manger « plus végétal », plus varié et moins transformé limite les risques pour notre santé (Sommer et al., 2017 ;Fardet et Rock, 2020) et permet de réduire les émissions de GES. Ces régimes alimentaires peuvent aussi indirectement contribuer à réduire le risque d'issues dramatiques aux pandémies en renforçant notre système immunitaire à tous les âges de la vie (Martinez, 2017). ...
Depuis le milieu du XX e siècle, les impacts des activités humaines sur les écosystèmes sont croissants. À l’érosion de la biodiversité et au dérèglement climatique, ainsi qu’au développement de maladies chroniques que constituent l’obésité et le diabète, s’ajoute désormais la pandémie du coronavirus. Il s’agit d’un ensemble de crises environnementales ou sanitaires qui résultent pour partie de facteurs communs et dont les impacts peuvent se conjuguer et s’amplifier. Dans ce contexte inédit, nos modes de production, transformation, distribution et consommation des aliments sont particulièrement interrogés. Ils sont à l’origine d’une part importante des émissions de gaz à effet de serre, participent à la destruction de certains habitats naturels réservoirs d’agents pathogènes et contribuent à l’émergence de maladies chroniques chez l’homme. De ce fait, la nécessité d’une transition de notre système alimentaire est une idée qui fait consensus, même si le choix des changements à opérer concrètement pose de nombreuses questions. À travers une approche systémique de « santé globale », rendant compte de l’interdépendance de l’état de santé de l’Homme, des animaux et des écosystèmes dans lesquels ils évoluent, nous montrons qu’il faut prioriser aussi bien les enjeux environnementaux que de santé pour mener à bien ces arbitrages. Nous montrons qu’il est possible de faire des choix doublement vertueux pour l’environnement et la santé en transformant les modes de production, de transformation, de distribution et de consommation des aliments : réorienter l’élevage, abaisser le degré de transformation des aliments, diversifier les modes de distribution et « végétaliser » notre assiette. Ces changements participent à la territorialisation du système alimentaire.
... Thus, the dietary pattern approach developed in the last two decades appears to be a very relevant research tool for public recommendations (Tapsell et al. 2016). Notably, all unraveled complex protective diets share in common the fact that they are rich in diversified plant-based foods and do not contain too many processed foods (Fardet and Rock 2018;Fardet and Rock 2020a). ...
Exclusive reductionism in nutritional science consists of viewing foods as only the sum of nutrients. This position paper argues that the extreme application of this paradigm since 1950 has greatly contributed to confusion about a healthy diet among consumers and to the development of chronic diseases worldwide. First, history of nutritional sciences in Western countries shows that by approximately 1850, laboratory research had mainly been conducted by reducing foods to nutrients that were interchangeable from one food to another. Second, descriptive and experimental studies show that the increased prevalence of chronic diseases mainly derive from ultra-processed foods. With such foods being representative of a final output in the degree of food processing, the relevance of reformulating food versus developing less unstructured processed foods is discussed. Third, the reductionist validation of food additives, randomized controlled trials, and food scoring is also questioned. Additionally, epidemiological studies that associate dietary patterns with the risk of chronic diseases and that aggregate approaches in nutrition, technology, food science and food scoring appear to be more adapted for nutritional recommendations in society. It is concluded that a complementary holistic perspective is needed to communicate to society about diet/food health potential and to efficiently prevent populations from chronic diseases.
... En résumé, manger « plus végétal », plus varié et moins transformé limite les risques pour notre santé (Sommer et al., 2017 ;Fardet et Rock, 2020) et permet de réduire les émissions de GES. Ces régimes alimentaires peuvent aussi indirectement contribuer à réduire le risque d'issues dramatiques aux pandémies en renforçant notre système immunitaire à tous les âges de la vie (Martinez, 2017). ...
Depuis le milieu du XXe siècle, les impacts des activités humaines sur les écosystèmes sont croissants. À l’érosion de la biodiversité et au dérèglement climatique, ainsi qu’au développement de maladies chroniques que constituent l’obésité et le diabète, s’ajoute désormais la pandémie du coronavirus. Il s’agit d’un ensemble de crises environnementales ou sanitaires qui résultent pour partie de facteurs communs et dont les impacts peuvent se conjuguer et s’amplifier. Dans ce contexte inédit, nos modes de production, transformation, distribution et consommation des aliments sont particulièrement interrogés. Ils sont à l’origine d’une part importante des émissions de gaz à effet de serre, participent à la destruction de certains habitats naturels réservoirs d’agents pathogènes et contribuent à l’émergence de maladies chroniques chez l’homme. De ce fait, la nécessité d’une transition de notre système alimentaire est une idée qui fait consensus, même si le choix des changements à opérer concrètement pose de nombreuses questions. À travers une approche systémique de « santé globale », rendant compte de l’interdépendance de l’état de santé de l’Homme, des animaux et des écosystèmes dans lesquels ils évoluent, nous montrons qu’il faut prioriser aussi bien les enjeux environnementaux que de santé pour mener à bien ces arbitrages. Nous montrons qu’il est possible de faire des choix doublement vertueux pour l’environnement et la santé en transformant les modes de production, de transformation, de distribution et de consommation des aliments : réorienter l’élevage, abaisser le degré de transformation des aliments, diversifier les modes de distribution et « végétaliser » notre assiette. Ces changements participent à la territorialisation du système alimentaire.
... On that basis and extended to an ethical and sustainable diet, three golden rules for designing a protective diet food system sustainability have been elaborated in our laboratory, and taking into consideration the neglected dimension of the degree of processing (second rule). In French, this new concept is called the 3Vs Rule for Végétal (animal calories not exceeding 15% per day), Vrai (real: ultra-processed calories not exceeding 15% per day), and Varié (varied real foods), using, if possible, local, seasonal, and organic products [42,133]. In line with previous collective experience searching for a generic complex diet protecting both human health and the planet as a whole with a time horizon of 2050 [7,31,32,[134][135][136][137][138][139][140], the 3Vs concept is based on a holistic view in that, through its application, it protects humans, animals, and the environment as a whole. ...
Global food systems are no longer sustainable for health, the environment, animal biodiversity and wellbeing, culinary traditions, socioeconomics, or small farmers. The increasing massive consumption of animal foods has been identified as a major determinant of unsustainability. However, today, the consumption of ultra-processed foods (UPFs) is also questioned. The main objective of this review is therefore to check the validity of this new hypothesis. We first identified the main ingredients/additives present in UPFs and the agricultural practices involved in their provision to agro-industrials. Overall, UPF production is analysed regarding its impacts on the environment, biodiversity, animal wellbeing, and cultural and socio-economic dimensions. Our main conclusion is that UPFs are associated with intensive agriculture/livestock and threaten all dimensions of food system sustainability due to the combination of low-cost ingredients at purchase and increased consumption worldwide. However, low-animal-calorie UPFs do not produce the highest greenhouse gas emissions (GHGEs) compared to conventional meat and dairy products. In addition, only reducing energy dense UPF intake, without substitution, might substantially reduce GHGEs. Therefore, significant improvement in food system sustainability requires urgently encouraging limiting UPF consumption to the benefit of mildly processed foods, preferably seasonal, organic, and local products.
The increasing global burden of morbidity and mortality from chronic diseases related to poor diet quality, coupled with the unsustainable depletion of vital planetary resources by current food production systems, threatens future food security and highlights the urgent need to transition to high-quality plant-based diets as a viable solution to mitigate economic, health, and environmental challenges. Taking into consideration the significant role that fermented vegetables may play as a sustainable, healthy, long-lasting, and plant-based nutritional resource, this narrative review analyzes their production and benefits. For this purpose, the mechanisms of the fermentation process are explored, along with the importance of probiotic cultures in plant-based fermented foods, and with the implications of fermentation on food safety within the broader framework of low-impact, organic, plant-derived nutrition. Additionally, the health benefits of fermented vegetables and probiotics are examined, including their effects on mental health. Vegetable fermentation is a versatile method for enhancing food preservation, nutritional quality, and safety. This ancient practice prolongs the shelf life of perishable items, reduces the toxicity of raw ingredients, and improves digestibility. Specific starter cultures, particularly lactic acid bacteria, are essential for controlling fermentation, ensuring safety, and maximizing health benefits. Fermented vegetables, rich in probiotics, support gut health and immune function. Emerging research indicates their potential to alleviate adverse mental health symptoms such as stress and anxiety, highlighting their significance in modern dietary guidelines and chronic health management.
Les sciences de la vie sont des disciplines holistiques et multidimensionnelles par essence, faisant intervenir des systèmes complexes comme les paysages agricoles, la chaîne agro-alimentaire ou le corps humain. Jusqu’à aujourd’hui tous ces domaines ont principalement été étudiés par une approche réductionniste en silo, générant toujours plus de mauvaise santé des systèmes complexes (pollution des sols, élevage intensif et antibiotiques, maladies chroniques chez l’homme…) que de durabilité à long terme. En fractionnant les systèmes à outrance et en coupant les liens entre leurs parties on génère de la maladie, de l’amont à l’aval. Dans cet article, nous mettrons en avant la nécessité de revenir à une approche empirico-inductive et holistique tout au long de la chaîne agro-alimentaire jusqu’au métabolisme chez l’homme, afin de générer des solutions pour des systèmes vivants durables et régénérateurs ; sans oublier la nécessite d’une éducation alimentaire aussi holistique.
L’alimentation préventive et durable est une discipline scientifique holistique par essence. Pour éviter l’écueil de l’approche en silo et réductionniste, entrainant du greenwashing, à savoir « verdir » une dimension seulement de l’ensemble, nous avons développé en 2016 la règle simple, générique, holistique et qualitative des 3VBLS (Vrai, Végétal, Varié, si possible Bio, Local et/ou de Saison) pour protéger la santé globale, humaine et planétaire (approche « one health »). Dans cet article nous en expliquerons brièvement sa genèse empirique, basée sur la redéfinition du potentiel santé d’un aliment et sur la dimension émergeante du degré de transformation des aliments. Puis nous présenterons son application dans trois pays, la France, la Chine et l’Inde. Au final, les 3VBLS constituent une métrique simple d’appropriation et facile d’utilisation au quotidien.
L’agriculture et l’alimentation sont au cœur de défis interdépendants : épuisement des ressources naturelles, pollutions, érosion de la biodiversité, dérèglement climatique, augmentation des maladies chroniques et infectieuses. De nouvelles approches intégratrices basées sur la santé sont nécessaires pour dépasser les approches « en silo » qui ne considèrent pas les multiples interdépendances entre la santé des humains, des animaux et l’environnement. Nous proposons le concept d’« Une seule santé » basé sur les interdépendances entre les santés humaine, animale, environnementale en distinguant pour cette dernière la santé des agroécosystèmes (échelle locale) et celle du « système Terre » (écosystèmes non cultivés, eau, atmosphère). De cette façon, il est possible de traiter explicitement des relations entre le système alimentaire, du champ à l’assiette, et les quatre domaines de santé, et ainsi de penser les changements à opérer pour relever les défis contemporains locaux et planétaires.
Les attentes sociales sont croissantes à l’égard de l’École pour prendre en charge l’éducation alimentaire des enfants et des adolescents. Cette dernière est appelée à répondre à des enjeux de plus en plus complexes, en particulier la croissance de la prévalence des maladies chroniques, des inégalités sociales de santé, ainsi que des défis environnementaux et agricoles. Cet article propose une réflexion croisée sur des approches pédagogiques aptes à concilier l’ensemble de ces finalités. Une analyse de la littérature scientifique et grise atteste de l’ambition, de plusieurs acteurs de l’éducation et de la recherche, de s’éloigner d’une éducation nutritionnelle verticale et transmissive et d’encourager l’apprentissage par l’expérience. Afin d’appuyer et de compléter cet élan éducatif, nous proposons trois principes pour penser des actions pédagogiques autour de l’alimentation à l’École que nous formulons à partir de la rencontre de deux recherches menées dans des écoles élémentaires et des collèges : prendre appui sur une approche holistique de l’alimentation, encourager la participation des élèves et ancrer les actions éducatives dans l’environnement de ces derniers. Ces propositions contribuent à penser une éducation alimentaire au plus proche des problématiques que rencontrent les élèves et les territoires au quotidien en matière d’alimentation.
Diet is a complex aggregate of foods and behaviors. The food is constituted of a wide variety of intended and unintended chemicals which may act singly on human metabolism, but more likely act in groups in a synergistic fashion. The study of nutrition and disease in aggregates of people—nutritional epidemiology—is hampered by the difficulty in accurately characterizing what people are eating. Reasons for this difficulty include the large day-to-day variability in what is eaten, finding efficient and accurate ways to collect dietary information, minimizing participant burden, and maximizing utility of the data for investigators. Much progress has been made in nutritional epidemiology in recent years owing to the use of food frequency questionnaires. These pose little participant burden and are relatively easy to analyze. However, such data collection instruments are still characterized by high within-person variation. They also severely limit collection of important details about the diet. A critical concept is whether the participant or the researcher synthesizes the dietary information, including issues such as defining the time period over which to average diet, what to do with unusual information, what constitutes a serving, how foods are grouped (for example, whether fruit juice and fruit drink are grouped together), and what emphasis to put on brand names. Progress has been made on protocol changes and computer technology advances that might allow more complete and accurate diet data collection, but problems still exist with these methods. It is important to study foods, food groups, and food patterns as well as nutrients and other substances contained in food. Where many substances in a food act synergistically, an association will be found with the food. There may or may not be associations with individual substances. The associations of food patterns with risk provide feedback to policy makers on the likely success of nutritional pronouncements.KeywordsNutritional epidemiologyMethods of dietary assessmentDietary recallFood frequency questionnaireBiomarkersDietary patterns
Background and Aims
Since the population may not be aware of UPF consumption as a result of ignorance or non-recognition, this study aimed to ascertain the main characteristics of subjects regarding their knowledge of different easily-acquired foods through a questionnaire in Google Forms format with 52 questions. Secondary objectives were to determine whether the profile of UPF consumers can be defined based on sex, age, sociodemographic factors and lifestyle.
Methods and Results
Responses were received from 1,037 participants from a convenience sample; of these, 83 (8.0%) were sporadic or non-users and 954 (92.0%) frequent UPF consumers. The participants of the upper tertile correctly matched >12 food items, those of the medium tertile 12-9 and those of the lower tertile <9. Factors independently associated with participants who better identified UPF (upper tertile) compared to those of the lower tertile (reference) were female sex (OR: 2.54, 95%CI: 1.70-3.79; p<0.001), age between 21 and 50 (OR: 3.63, 95%CI: 2.56-5.15; p<0.001), living with family (OR: 0.64, 95%CI: 0.41-9.96; p=0.033) and eating more fruit (≥ 3 pieces/day, OR: 2.30, 95%CI: 1.61-3.27; p<0.001).
Conclusions
These findings highlight the high consumption and low degree of awareness of UPF among consumers based mainly on food composition.
The adoption of more sustainable diets (SD) has the capacity to meet the needs of individuals without compromising future generations' abilities to do the same. Nutrition educators are ideal candidates for delivering SD education to consumers, yet evidence-based recommendations for the profession have not been crafted. The results of a thorough, narrative review of the literature performed in 2021 suggest there are five well-supported recommendations nutrition educators should consider incorporating in their work. They are (1) shift towards a plant-based diet, (2) mitigate food waste, (3) limit consumption of ultra-processed foods (UPF), (4) engage in local food systems, and (5) choose sustainable seafood. Each recommendation is discussed below in detail, to provide nutrition educators with a nuanced scope of the issue, after which suggestions for the inclusion of these recommendations, using an example of the authors' experiences from the US Expanded Food and Nutrition Education Program (EFNEP), are provided.
Objective: To extend analyses of nutrition transition in developed countries to China within the framework of the 3Vs rule considering degree of processing starting with industrially processed foods (IPFs, Rule 1), plant/animal calorie ratio (Rule 2), and food diversity through nutrient intakes (Rule 3).
Design: Total and main food group (n = 13) calorie intakes, percentages of animal and IPF calories, adequacy of the Dietary Reference Intake (DRI) and prevalence of chronic diseases were retrieved from scientific literature and international databases.
Setting: China, 1990-2019
Participants: Overall population
Results: The total calorie intake decreased by 9% over thirty years while the prevalence of chronic diseases substantially increased. Percentages of IPFs (Rule 1) and animal (Rule 2) calorie intake shifted from 9 to 30% and 2 to 30%, respectively. Meanwhile, the overall DRI adequacy (Rule 3) did not improve, with calcium and retinol deficiencies in 2019, and, although remaining above DRI, iron, copper, magnesium, and vitamins E, C and B1-B9 intakes regularly decreased. Notably, the prevalence of obesity increased five-fold, paralleling the exponential increase in IPF calorie intake. Both sources of calories were highly correlated with prevalence of main chronic diseases.
Conclusions: Despite a slight decreased of total calorie consumption and rather good compliance with DRI, the farther the Chinese population moved away from the 3Vs rule during the 1990-2019 period, the more the prevalence of chronic diseases increased. Further analyses on foods’ transitions will be better assessed when advocating sources/quality of calories (Rules 1/2), rather than only nutrient composition (Rule 3).
Agri-food systems (AFS) have been central in the debate on sustainable development. Despite this growing interest in AFS, comprehensive analyses of the scholarly literature are hard to find. Therefore, the present systematic review delineated the contours of this growing research strand and analyzed how it relates to sustainability. A search performed on the Web of Science in January 2020 yielded 1389 documents, and 1289 were selected and underwent bibliometric and topical analyses. The topical analysis was informed by the SAFA (Sustainability Assessment of Food and Agriculture systems) approach of FAO and structured along four dimensions viz. environment, economy, society and culture, and policy and governance. The review shows an increasing interest in AFS with an exponential increase in publications number. However, the study field is north-biased and dominated by researchers and organizations from developed countries. Moreover, the analysis suggests that while environmental aspects are sufficiently addressed, social, economic, and political ones are generally overlooked. The paper ends by providing directions for future research and listing some topics to be integrated into a comprehensive, multidisciplinary agenda addressing the multifaceted (un)sustainability of AFS. It makes the case for adopting a holistic, 4-P (planet, people, profit, policy) approach in agri-food system studies.
Background
The concepts of sustainability and food systems have developed over time and their definitions vary depending on different discipline perspectives. There has been an evolution of the term sustainability, particularly as it relates to the sustainability of food systems. However, most discussions around food systems sustainability focus on food production and nutrition, and omit considerations of major parts of the food value chain, notably food processing and preparation.
Scope and approach
In this review, the transitions required to move from linear food chains to closed loop systems to the wider food web for more sustainable food systems are discussed. The interdependencies between resource use, the activities in the food chain and various sustainability indicators are considered. A model for stimulating discussion about the complexity of value chains in the food web is presented.
Key findings and conclusions
There is an urgent need for radical change in the food system to ensure the long term sustainability of the planet. Clear, understandable and globally accepted definitions and indicators for sustainability need to be developed. The increasing complexities in food value chains have to be considered when developing solutions for enhancing food systems sustainability. Food processing and preparation have crucial roles in transforming existing food systems to make them more sustainable. A systems-based approach to developing sustainable food systems, that includes improving natural resource use, reducing environmental impact, examining new food resources, enhancing consumer trust and understanding, and developing profitable market opportunity-led solutions for food and nutrition security, is required.
Notre santé et nos systèmes alimentaires ne sont plus durables. En cause
notamment un excès de consommation de calories d’origine animales et ultra-transformées. La règle générique des 3VBLS a été élaborée pour répondre à cet
enjeu : Végétal (15% max de calories de produits d’origine animales/jour, soit
environ 2-3 portions de viandes, produits laitiers, œufs, poissons, etc.), Vrai
(15% max de calories d’aliments ultra-transformés/jour, 1-2 portions), Varié, si
possible Bio, Local et de Saison. S’affranchissant de l’approche par nutriments,
elle permet de remplir tous les besoins nutritionnels chez l’adulte. L’objectif de
cette nouvelle étude a été de tester l’applicabilité de la théorie des 3VBLS chez
les enfants français de 3-10 ans au regard de leurs besoins nutritionnels, en
comparaison avec leur régime standard moyen tel que rapporté dans l’étude
INCA3 (2014-2015, n = 1035 enfants). Le régime standard INCA3 est composé
d’environ 37% de calories animales et 47% de calories ultra-transformées avec
une diversification assez limitée (faible représentativité des céréales complètes,
légumineuses, fruits à coque, poissons et œufs, et forte représentativité des fruits
frais et produits laitiers). Le régime 3VBLS, avec une grande diversité d’aliments,
notamment végétaux, est nutritionnellement adéquat. Il reste la question de son
acceptabilité et de son coût à plus long terme
Global food systems are no longer sustainable for health, the environment, animal biodiversity and wellbeing, culinary traditions, socioeconomics, or small farmers. The increasing massive consumption of animal foods has been identified as a major determinant of unsustainability. However, today, the increasing consumption of ultra-processed foods (UPFs) worldwide is also questioned. Up today, more than 40 epidemiological studies have shown that excess UPF consumption significantly increase the risks of several chronic diseases and all-cause mortality. Concerning the other dimensions of sustainability, we attempted, based on the collection of scattered data from scientific literature, to build the interrelations between massive UPF consumption and impacts on food systems. For this, we first identified the main ingredients/additives present in UPFs and the agricultural practices involved in their provision to agro-industrials. Overall, UPF production is analyzed regarding its impacts on the environment, biodiversity, animal wellbeing, and cultural and socioeconomic dimensions. Our main conclusion is that UPFs are associated with intensive agriculture/livestock and threaten all dimensions of food system sustainability due to the combination of low-cost ingredients at purchase and increased consumption worldwide. However, plant-based UPFs do not produce the highest greenhouse gas emissions (GHGEs) compared to conventional meat and dairy products. In addition, only reducing energy-dense UPF consumption (associated with excess calorie intakes), without substitution, might substantially reduce GHGEs. Therefore, significant improvement in food system sustainability requires urgently encouraging limiting UPF consumption to the benefit of mildly processed foods, preferably seasonal, organic and local products, a recommendation that we formalized in the concept of the 3V-based diet for Végétal (Plant), Vrai (Real foods), Varié (Varied, preferably organic, local and seasonal-when possible).
Background:
High consumption of red meat, which is carcinogenic to humans, and misuse or abuse of alcohol drinking increase premature death and shortened life expectancy. The aim of this study was to examine the association of alcohol and red meat consumption with life expectancy (LE) by analyzing data from 164 countries using an ecological approach.
Design:
This was a longitudinal ecological study using data from the United Nation's (UN) Food and Agriculture Organization (FAO) for 164 countries over the period 1992-2013. In regression analysis, the relationship of alcohol and red meat consumption with LE was estimated using a pooled ordinary least squares regression model. Alcohol and red meat consumption were measured every 5 years.
Results:
The consumption of alcohol and red meat in high-income countries (HIC) was about 4 times (36.8-143.0 kcal/capita/day) and 5 times (11.2-51.9 kcal/capita/day) higher than that in low-income countries (LIC). Red meat and alcohol consumption had a negative estimated effect on LE in HIC (b = -1.616 p = <0.001 and b = -0.615, p = 0.003). Alcohol consumption was negatively associated with LE for all income groups, while positive relationships were found for all estimates associated with gross national income (GNI).
Conclusions:
Red meat and alcohol consumption appeared to have a negative impact on LE in high-income countries (HIC) and upper-middle-income countries (UMIC), although it had no significant association with LE in low-income countries (LIC) or lower-middle-income countries (LMIC). This study suggests reviewing the policies on the gradual reduction of alcohol abuse and the high consumption of red meat, particularly HIC and UMIC.
Sustainable food systems are essential for meeting nutritional requirements, limiting environmental impacts, and reducing animal welfare loss. Although current dietary trends in many regions rather go in the opposite direction, the adequacy of dietary guidelines is unknown, and the three sustainability dimensions are generally not assessed simultaneously. Here, we assessed nation-specific recommended diets for these impacts compared with the average diet. We assessed the trade-offs between nutritional quality, environmental sustainability (carbon, land, and water footprints), and animal welfare. Most countries reduce their animal product consumption in terms of food calories when switching to the nationally recommended diet. Recommended diets have the potential for “win-win-wins” in all three categories when compared with the current average diet, such as that shown in Brazil. However, South Korea loses in all three regards, and many other countries face trade-offs. This highlights the scope for the optimization of dietary guidelines to minimize such trade-offs.
Despite the nutritional value of meat, a large volume of reviews and meta-analyses suggests that processed meat intake is associated with an increased risk of chronic diseases. However, assessments of the quality of these published reviews internal validity are generally lacking. We systematically reviewed and assessed the quality alongside summarizing the results of previously published systematic reviews and meta-analyses that examined the association between processed meat intake and cancers, type II diabetes (T2D), and cardiovascular diseases (CVD). Reviews and meta-analyses published until May 2018 were identified through a systematic literature search in the databases MEDLINE and EMBASE, and reference lists of included reviews. The quality of the systematic reviews and meta-analyses was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR). All eligible reviews had to comply with two quality requirements: providing sufficient information on quality assessment of the primary studies and a comprehensive search. The results were summarized for T2D, CVD, and each of the different cancer types. The certainty in the estimates of the individual outcomes was rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. In total, 22 systematic reviews were eligible and thus included in this review. More than 100 reviews were excluded because quality assessment of the primary studies had not been performed. The AMSTAR score of the included reviews ranged from 5 to 8 indicating moderate quality. Overall, the quality assessments of primary studies of the reviews are generally lacking; the scientific quality of the systematic reviews reporting positive associations between processed meat intake and risk of various cancers, T2D and CVD is moderate, and the results from case-control studies suggest more often a positive association than the results from cohort studies. The overall certainty in the evidence was very low across all individual outcomes, due to serious risk of bias and imprecision.
Objective
To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.
Design
We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity.
Setting
Brazil.
Participants
Civil servants of Brazilian public academic institutions in six cities ( n 11 827), aged 35–74 years at baseline (2008–2010).
Results
UPF provided a mean 24·6 ( sd 9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %) v . first (<17·8 %) quartile of UPF consumption was associated (relative risk (95 % CI)) with 27 and 33 % greater risk of large weight and waist gains (1·27 (1·07, 1·50) and 1·33 (1·12, 1·58)), respectively. Similarly, those in the fourth consumption quartile presented 20 % greater risk (1·20 (1·03, 1·40)) of incident overweight/obesity and 2 % greater risk (1·02; (0·85, 1·21)) of incident obesity. Approximately 15 % of cases of large weight and waist gains and of incident overweight/obesity could be attributed to consumption of >17·8 % of energy as UPF.
Conclusions
Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide.
Globally, two billion people suffer from micronutrient deficiencies, 151 million children under five suffer from stunting, and millions more have impaired cognitive development related to poor nutrition. This is partly due to insufficient consumption of animal-sourced foods (ASF), which supply multiple bioavailable nutrients that are lacking in the cereal-based diets of the poor. Yet, reports like the one recently published by the EAT-Lancet Commission, solely focus on the threat of ASF consumption on sustainability and human health, overestimate and ignore the tremendous variability in the environmental impact of livestock production, and fail to adequately include the experience of marginalized women and children in low- and middle-income countries whose diets regularly lack the necessary nutrients. Yet animal-source foods have been described by the World Health Organization as the best source of high-quality nutrient-rich food for children aged 6–23 months. Livestock and ASF are vital to sustainability as they play a critical role in improving nutrition, reducing poverty, improving gender equity, improving livelihoods, increasing food security, and improving health. The nutritional needs of the world's poor, particularly women and children, must be considered in sustainability debates.
Objective:
To assess the prospective association between ultra-processed food consumption and all-cause mortality and to examine the effect of theoretical iso-caloric non-processed foods substitution.
Patients and methods:
A population-based cohort of 11,898 individuals (mean age 46.9 years, and 50.5% women) were selected from the ENRICA study, a representative sample of the noninstitutionalized Spanish population. Dietary information was collected by a validated computer-based dietary history and categorized according to their degree of processing using NOVA classification. Total mortality was obtained from the National Death Index. Follow-up lasted from baseline (2008-2010) to mortality date or December 31th, 2016, whichever was first. The association between quartiles of consumption of ultra-processed food and mortality was analyzed by Cox models adjusted for the main confounders. Restricted cubic-splines were used to assess dose-response relationships when using iso-caloric substitutions.
Results:
Average consumption of ultra-processed food was 385 g/d (24.4% of the total energy intake). After a mean follow-up of 7.7 years (93,599 person-years), 440 deaths occurred. The hazard ratio (and 95% CI) for mortality in the highest versus the lowest quartile of ultra-processed food consumption was 1.44 (95% CI, 1.01-2.07; P trend=.03) in percent of energy and 1.46 (95% CI, 1.04-2.05; P trend=.03) in grams per day per kilogram. Isocaloric substitution of ultra-processed food with unprocessed or minimally processed foods was associated with a significant nonlinear decrease in mortality.
Conclusion:
A higher consumption of ultra-processed food was associated with higher mortality in the general population. Furthermore, the theoretical iso-caloric substitution ultra-processed food by unprocessed or minimally processed foods would suppose a reduction of the mortality risk. If confirmed, these findings support the necessity of the development of new nutritional policies and guides at the national and international level.
Trial registration:
clinicaltrials.gov Identifier: NCT01133093.
“The Nordic diet” is an umbrella term that encompasses any interpretation that combines Food-Based Dietary Guidelines (FBDGs) with local Nordic foods. The five Nordic countries have collaborated on Nordic Nutrition Recommendations for forty years, including FBDGs, so their national guidelines are similar. The countries also share similar public health issues, including widespread nonconformity to the guidelines, although in different ways. The aim of this concept paper is to discuss environmental sustainability aspects of the Nordic diet, describe the status of and make suggestions for the inclusion of sustainability in future work on the Nordic diet. We exploit the sustainability–health synergy. A food intake more in line with the current FBDGs, which emphasises more plant-based and less animal-based foods, is necessary for high environmental sustainability. In turn, sustainability is an important motivator for health-promoting dietary shifts. Policy development requires long-term efforts. Since the Nordic diet can be considered a further development and improvement of old, traditional diets, there is huge potential to formulate a Nordic diet that benefits both human and planetary health. It is time for concerted engagement and actions—a new Nordic nutrition transition.
Objective
This study aimed to describe the consumption of ultra-processed foods in Australia and its association with the intake of nutrients linked to non-communicable diseases (NCDs).
Design
Cross-sectional study.
Setting
National Nutrition and Physical Activity Survey (2011-2012).
Participants
12,153 participants aged 2+ years.
Main outcome measures
Average dietary content of nutrients linked to NCDs and the prevalence of intake outside levels recommended for the prevention of NCDs.
Data analysis
Food items were classified according to the NOVA system, a classification based on the nature, extent and purpose of industrial food processing. The contribution of each NOVA food group and their subgroups to total energy intake was calculated. Mean nutrient content of ultra-processed food and non-ultra-processed food fractions of the diet were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of nutrients linked to NCDs as well as in the prevalence of intakes outside levels recommended for the prevention of NCDs were examined.
Results
Ultra-processed foods had the highest dietary contribution (42.0% of energy intake), followed by unprocessed or minimally processed foods (35.4%), processed foods (15.8%) and processed culinary ingredients (6.8%). A positive and statistically significant linear trend was found between quintiles of ultra-processed food consumption and intake levels of free sugars (standardised β 0.43, p<0.001); total (β 0.08, p<0.001), saturated (β 0.18, p<0.001) and trans fats (β 0.10, p<0.001); sodium (β 0.21, p<0.001) and diet energy density (β 0.41, p<0.001), while an inverse relationship was observed for dietary fibre (β -0.21, p<0.001) and potassium (β -0.27, p<0.001). The prevalence of non-recommended intake levels of all studied nutrients increased linearly across quintiles of ultra-processed food intake, notably from 22% to 82% for free sugars, from 6% to 11% for trans fat and from 2% to 25% for dietary energy density, from the lowest to the highest ultra-processed food quintile.
Conclusion
The high energy contribution of ultra-processed foods impacted negatively on the intake of non-ultra-processed foods and on all nutrients linked to NCDs in Australia. Decreasing the dietary share of ultra-processed foods would substantially improve the diet quality in the country and help the population achieve recommendations on critical nutrients linked to NCDs.
Background:
The Paleolithic diet has been studied in the scope of prevention and control of chronic noncommunicable diseases (CNCD). The objective of this study was to analyze the influence of the Paleolithic diet on the prevention and control of CNCD in humans, specifically on anthropometric markers, through a systematic review with meta-analysis.
Methods:
What is the effect of the Paleolithic diet on anthropometric parameters (weight, body mass index and waist circumference) compared to other control diets based on recommendations in adults? We included only randomized studies with humans that used the Paleolithic Diet in the prevention and control of CNCD published in Portuguese, English or Spanish. The search period was until March 2019, in the LILACS, PubMed, Scielo, Science Direct, Medline, Web of Science and Scopus databases. The abstracts were evaluated by two researchers. We found 1224 articles, of which 24 were selected and 11 were included in the meta-analysis. The effect of dietary use on body weight, body mass index and waist circumference was evaluated.
Results:
The summary of the effect showed a loss of - 3.52 kg in the mean weight (CI 95%: - 5.26; - 1.79; p < 0,001; I2 = 24%) of people who adopted the Paleolithic diet compared to diets based on recommendations. The analysis showed a positive association of adopting the Paleolithic diet in relation to weight loss. The effect was significant on weight, body mass index and waist circumference.
Conclusion:
The Paleolithic diet may assist in controlling weight and waist circumference and in the management of chronic diseases. However, more randomized clinical studies with larger populations and duration are necessary to prove health benefits.
Trial registration:
CRD42015027849 .
There is some evidence supporting the beneficial effects of a Paleolithic Diet (PD) on cardiovascular disease risk factors. This diet advises consuming lean meat, fish, vegetables, fruits, and nuts and avoiding intake of grains, dairy products, processed foods, and added sugar and salt. This study was performed to assess the effects of a PD on cardiovascular disease risk factors including anthropometric indexes, lipid profile, blood pressure, and inflammatory markers using data from randomized controlled trials. A comprehensive search was performed in the PubMed, Scopus, ISI Web of Science, and Google Scholar databases up to August, 2018. A meta-analysis was performed using a random-effects model to estimate the pooled effect size. Meta-analysis of 8 eligible studies revealed that a PD significantly reduced body weight [weighted mean difference (WMD) = −2.17 kg; 95% CI: −3.48, −0.87 kg], waist circumference (WMD = −2.90 cm; 95% CI: −4.51, −1.28 cm), body mass index (in kg/m 2) (WMD = −1.15; 95% CI: −1.68, −0.62), body fat percentage (WMD = −1.38%; 95% CI: −2.08%, −0.67%), systolic (WMD = −4.24 mm Hg; 95% CI: −7.11, −1.38 mm Hg) and diastolic (WMD = −2.95 mm Hg; 95% CI: −4.72, −1.18 mm Hg) blood pressure, and circulating concentrations of total cholesterol (WMD = −0.22 mg/dL; 95% CI: −0.42, −0.03 mg/dL), TGs (WMD = −0.23 mg/dL; 95% CI: −0.46, −0.01 mg/dL), LDL cholesterol (WMD = −0.13 mg/dL; 95% CI: −0.25, −0.01 mg/dL), and C-reactive protein (CRP) (WMD = −0.41 mg/L; 95% CI: −0.81, −0.008 mg/L) and also significantly increased HDL cholesterol (WMD = 0.05 mg/dL; 95% CI: 0.005, 0.10 mg/dL). However, sensitivity analysis revealed that the overall effects of a PD on lipid profile, blood pressure, and circulating CRP concentrations were significantly influenced by removing some studies, hence the results must be interpreted with caution. Although the present meta-analysis revealed that a PD has favorable effects on cardiovascular disease risk factors, the evidence is not conclusive and more well-designed trials are still needed. Adv Nutr 2019;0:1-13.
Background:
Ultra-processed foods are highly palatable and can be consumed anywhere at any time, but typically have a poor nutritional profile. Therefore, their contribution to total energy intake has been proposed as an indicator for studying overall dietary quality.
Objective:
The aim of this study was to investigate the associations between the energy contribution from ultra-processed foods and the intake of nutrients related to chronic non-communicable diseases in Mexico.
Design:
This study used a secondary analysis of cross-sectional data from the 2012 Mexican National Health and Nutrition Survey.
Participants/setting:
This study included participants aged 1 year and older (n=10,087) who had completed a 1-day 24-hour recall.
Main outcome measures:
Intake from added sugar (% kcal), total fat (% kcal), saturated fat (% kcal), protein (% kcal), dietary fiber (g/1,000 kcal), and dietary energy density (kcal/g) were measured.
Statistical analysis:
Multiple linear regression models adjusted for sociodemographic variables were fitted to assess the association between quintiles of energy contribution from ultra-processed foods and nutrient intake.
Results:
Mean reported energy contribution from ultra-processed foods to the Mexican population's diet ranged from 4.5% kcal in quintile 1 (Q1) to 64.2% kcal in quintile 5 (Q5). An increased energy contribution from ultra-processed foods was positively associated with intake from added sugar (Q1: 7.4% kcal; Q5: 17.5% kcal), total fat (Q1: 30.6% kcal; Q5: 33.5% kcal) and saturated fat (Q1: 9.3% kcal; Q5: 13.2% kcal), as well as dietary energy density (Q1: 1.4 kcal/g; Q5: 2.0 kcal/g) (P≤0.001); and inversely associated with intake from protein (Q1: 15.1% kcal; Q5: 11.9% kcal) and dietary fiber (Q1: 16.0 g/1,000 kcal; Q5: 8.4 g/1,000 kcal) (P≤0.001).
Conclusions:
In the Mexican population, an increased energy contribution from ultra-processed foods was associated with a lower dietary quality with regard to intake of nutrients related to chronic non-communicable diseases. Future research is needed to identify barriers to eating a variety of unprocessed and minimally processed foods for the Mexican population, as well as effective public health strategies and policies to overcome these barriers.
Background: Vegetarian dietary patterns are recommended for cardiovascular disease (CVD) prevention and management due to their favorable effects on cardiometabolic risk factors, however, the role of vegetarian dietary patterns in CVD incidence and mortality remains unclear.
Objective: To update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we undertook a systematic review and meta-analysis of the association of vegetarian dietary patterns with major cardiovascular outcomes in prospective cohort studies that included individuals with and without diabetes using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Methods: MEDLINE, EMBASE, and Cochrane databases were searched through September 6th, 2018. We included prospective cohort studies ≥1 year of follow-up including individuals with or without diabetes reporting the relation of vegetarian and non-vegetarian dietary patterns with at least one cardiovascular outcome. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). The pre-specified outcomes included CVD incidence and mortality (total CVD, coronary heart disease (CHD) and stroke). Risk ratios for associations were pooled using inverse variance random effects model and expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I²-statistic). The overall certainty of the evidence was assessed using GRADE.
Results: Seven prospective cohort studies (197,737 participants, 8,430 events) were included. A vegetarian dietary pattern was associated with reduced CHD mortality [RR, 0.78 (CI, 0.69, 0.88)] and incidence [0.72 (0.61, 0.85)] but were not associated with CVD mortality [0.92 (0.84, 1.02)] and stroke mortality [0.92 (0.77, 1.10)]. The overall certainty of the evidence was graded as “very low” for all outcomes, owing to downgrades for indirectness and imprecision.
Conclusions: Very low-quality evidence indicates that vegetarian dietary patterns are associated with reductions in CHD mortality and incidence but not with CVD and stroke mortality in individuals with and without diabetes. More research, particularly in different populations, is needed to improve the certainty in our estimates.
Clinical Trial Registration: Clinicaltrials.gov, identifier: NCT03610828.
Objective
To evaluate the association of changes in red meat consumption with total and cause specific mortality in women and men.
Design
Two prospective cohort studies with repeated measures of diet and lifestyle factors.
Setting
Nurses’ Health Study and the Health Professionals Follow-up Study, United States.
Participants
53 553 women and 27 916 men without cardiovascular disease or cancer at baseline.
Main outcome measure
Death confirmed by state vital statistics records, the national death index, or reported by families and the postal system.
Results
14 019 deaths occurred during 1.2 million person years of follow-up. Increases in red meat consumption over eight years were associated with a higher mortality risk in the subsequent eight years among women and men (both P for trend<0.05, P for heterogeneity=0.97). An increase in total red meat consumption of at least half a serving per day was associated with a 10% higher mortality risk (pooled hazard ratio 1.10, 95% confidence interval 1.04 to 1.17). For processed and unprocessed red meat consumption, an increase of at least half a serving per day was associated with a 13% higher mortality risk (1.13, 1.04 to 1.23) and a 9% higher mortality risk (1.09, 1.02 to 1.17), respectively. A decrease in consumption of processed or unprocessed red meat of at least half a serving per day was not associated with mortality risk. The association between increased red meat consumption and mortality risk was consistent across subgroups defined by age, physical activity, dietary quality, smoking status, or alcohol consumption.
Conclusion
Increases in red meat consumption, especially processed meat, were associated with higher overall mortality rates.
In the last decade, a number of meta-analyses of mostly observational studies evaluated the relation between the intake of food groups and the risk of noncommunicable diseases (NCDs). In this study, we systematically reviewed dose-response meta-analyses of prospective studies with the aim to derive the quantities of food to consume to attain a protective (Mediterranean food) or a non-adverse (non-Mediterranean food) effect toward selected NCDs such as cardiovascular disease (CVD) including coronary heart disease (CHD) and stroke, type 2 diabetes (T2DM), colorectal (CRC) and breast cancer. These derived quantities, wherever possible, were suggested for a quantification of food servings of the Mediterranean Diet Pyramid proposed for Italian People (MDPPI). This pyramid came from the Modern Mediterranean Diet Pyramid developed in 2009 for Italian people. A weekly menu plan was built on the advice about frequency of intakes and serving sizes of such pyramid and the nutritional composition of this diet was compared with the Reference Italian Mediterranean Diet followed in 1960 in Nicotera. The diet built according the advice of MDPPI was very similar to that of Nicotera in the late 1950s that has been chosen as Italian Reference Mediterranean Diet with the exception of percentage of energy provided by cereals that was lower and of fruits and vegetables that was higher. Saturated fatty acids were only the 6% of daily energy intake. Also the Mediterranean Adequacy Index (MAI) was very similar to that of the aforementioned diet.
Objective
To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases.
Design
Population based cohort study.
Setting
NutriNet-Santé cohort, France 2009-18.
Participants
105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants’ usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing.
Main outcome measures
Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors.
Results
During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P<0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses.
Conclusions
In this large observational prospective study, higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods.
Study registration
ClinicalTrials.gov NCT03335644 .
Objective: To evaluate the association between consumption of ultra-processed foods and all cause mortality.
Design: Prospective cohort study.
Setting: Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018.
Participants: 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire.
Main outcome measure: Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models.
Results: 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33).
Conclusions: A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%.
Background: The NOVA food classification scheme divides foods into ultra-processed, processed, unprocessed, and culinary ingredients. Ultra-processed foods contribute >60% of energy to diets in the US.
Objective: To characterize ultra-processed foods by energy density, nutrient density, and monetary cost.
Methods: The 384 component foods of Fred Hutch (FHCRC) food frequency questionnaire (FFQ), were assigned to 4 NOVA categories and to 7 USDA MyPyramid food groups. Energy density was kcal/g. Nutrient density was measured using the Nutrient Rich Food index NRF9.3. Food prices were collected in local supermarkets from 2004 to 2016. Analyses examined time trends in food prices by NOVA category and by USDA food group.
Results: The ultra-processed classification captured mostly grains (91%), fats and sweets (73%), dairy (71%), and beans, nuts and seeds (70%), but only 36% of meat, poultry and fish, 26% of vegetables, and 20% of fruit. Compared to unprocessed foods, ultra-processed foods had lower nutrient density (NRF9.3 per 100 kcal: 21.2 vs. 108.5),higher energy density (mean (SD): 2.2 vs. 1.10 in kcal/g), and lower per calorie cost (0.55 vs. 1.45 in $/100 kcal). Ultra-processed foods did not increase in price as much as unprocessed foods over the 12 year period.
Conclusion: Ultra-processed foods tend to be energy-dense, low-cost, and nutrient-poor. Low energy cost could be one mechanism linking ultra-processed foods with negative health outcomes. Food-based Dietary Guidelines may need to address food processing in relation to economic aspects of food choice.
A previous meta-analysis provided convincing evidence for an inverse association between adherence to a Mediterranean diet (MedDiet) and the risk of all-cause mortality. Since then, 19 prospective studies have published new findings. We updated the evidence from prospective studies and conducted a dose-response meta-analysis to test the linear and potential nonlinear dose-response associations between adherence to a MedDiet and risk of all-cause mortality. The bibliographical databases of PubMed, Scopus, ISI web of knowledge and Embase were systematically searched up to 24 Agoust 2018. Summary hazard ratios (HRs) were estimated using a random-effects meta-analysis to assess the association between a 2-point increment in MedDiet adherence and the risk of all-cause mortality. Sensitivity and subgroup analyses were performed and potential publication bias was tested. Twenty-nine prospective studies with 1,676,901 participants and 221,603 cases of all-cause mortality were included in the final analysis. The pooled HR of all-cause mortality was 0.90 (95% CI: 0.89, 0.91; I2 = 81.1%) for a 2-point increment in adherence to a MedDiet. Subgroup analyses showed that a significant inverse association was stronger in participants who were living in the Mediterranean regions compared to non-Mediterranean areas (HRs: 0.82 vs. 0.92, respectively), and in studies that used the Panagiotakos MedDiet score. A nonlinear dose-response meta-analysis indicated that the risk of all-cause mortality linearly decreased with the increase in adherence to a MedDiet. The robustness of findings was confirmed in the sensitivity analyses. In conclusion, evidence from prospective cohort studies is suggestive of an inverse association between adherence to a MedDiet and the risk of all-cause mortality, especially in Mediterranean regions. An inverse linear dose-response relationship was observed between MedDiet adherence and risk of all-cause mortality.
The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).
Processed meat and red meat have been associated with increased mortality, but studies are inconsistent and few have investigated substitution by other protein sources. The relationship of overall and causes-specific mortality with red meat, processed meat, and other dietary protein sources was investigated in The Netherlands Cohort Study. In 1986, 120,852 men and women aged 55–69 years provided information on dietary and lifestyle habits. Mortality follow-up until 1996 consisted of linkage to statistics Netherlands. Multivariable case-cohort analyses were based on 8823 deaths and 3202 subcohort members with complete data on diet and confounders. Red meat (unprocessed) intake was not associated with overall and cause-specific mortality. Processed meat intake was significantly positively related to overall mortality: HR (95% CI) comparing highest versus lowest quintile, 1.21 (1.02–1.44) with Ptrend = 0.049. Significant associations were observed for cardiovascular [HR Q5 vs. Q1, 1.26 (1.01–1.26)] and respiratory [HR = 1.79 (1.19–2.67)], but not cancer mortality [HR = 1.16 (0.97–1.39)]. Adjustment for nitrite intake attenuated these associations which became nonsignificant: HRs Q5 versus Q1 (95% CI) were: 1.10 (0.77–1.55) for total, 1.09 (0.71–1.67) for cardiovascular, 1.44 (0.68–3.05) for respiratory, and 1.11 (0.78–1.58) for cancer mortality. Nitrite was significantly associated with overall, CVD and respiratory mortality. Poultry intake was significantly inversely related to cancer and overall mortality. While fish intake showed positive associations, nut intake showed inverse associations with all endpoints. Replacing processed meat with a combination of poultry, eggs, fish, pulses, nuts and low-fat dairy was associated with lower risks of overall, cardiovascular and respiratory mortality. Processed meat was related to increased overall, CVD and respiratory mortality, potentially due to nitrite. Substituting processed meat with other protein sources was associated with lower mortality risks.
Electronic supplementary material
The online version of this article (10.1007/s10654-019-00483-9) contains supplementary material, which is available to authorized users.
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.
A sustainable diet is, by definition, nutritionally adequate, economically affordable, culturally acceptable, and environmentally respectful. Designing such a diet has to integrate different dimensions of diet sustainability that may not be compatible with each other. Among multicriteria assessment methods, diet optimization is a whole-diet approach that simultaneously combines several metrics for dimensions of diet sustainability. This narrative review based on 67 published studies shows how mathematical diet optimization can help with understanding the relations between the different dimensions of diet sustainability and how it can be properly used to identify sustainable diets. Diet optimization aims to find the optimal combination of foods for a population, a subpopulation, or an individual that fulfills a set of constraints while minimizing or maximizing an objective function. In the studies reviewed, diet optimization was used to examine the links between dimensions of diet sustainability, identify the minimum cost or environmental impact of a nutritionally adequate diet, or identify food combinations able to combine ≥2 sustainability dimensions. If some constraints prove difficult to fulfill, this signals an incompatibility between nutrient recommendations, over-monotonous food-consumption patterns, an inadequate supply of nutrient-rich foods, or an incompatibility with other dimensions. If diet optimization proves successful, it can serve to design nutritionally adequate, culturally acceptable, economically affordable, and environmentally friendly diets. Diet optimization results can help define dietary recommendations, tackle food security issues, and promote sustainable dietary patterns. This review emphasizes the importance of carefully choosing the model parameters (variables, objective function, constraints) and input data and the need for appropriate expertise to correctly interpret and communicate the results. Future research should make improvements in the choice of metrics used to assess each aspect of a sustainable diet, especially the cultural dimension, to improve the practicability of the results.
Objectives
To assess the association between consumption of ultra-processed foods and obesity in the Canadian population.
Methods
Cross-sectional study including 19,363 adults aged 18 years or more from the 2004 Canadian Community Health Survey, cycle 2.2. Ultra-processed food intake was estimated using daily relative energy intake of ultra-processed food (% of total energy intake) from data obtained by 24-h food recalls. Obesity was assessed using body mass index (BMI ≥ 30 kg/m²). Univariate and multivariate linear regressions were performed to describe ultra-processed food consumption according to socio-economic and demographic variables, and multivariate logistic regression was performed to verify the association between ultra-processed food consumption and obesity, adjusting for potential confounders, including socio-demographic factors, physical activity, smoking, immigrant status, residential location, and measured vs self-reported weight and height.
Results
Ultra-processed foods make up almost half (45%) of the daily calories consumed by Canadian adults. Consumption of these foods is higher among men, younger adults, those with fewer years of formal education, smokers, those physically inactive, and Canadian-born individuals. Ultra-processed food consumption is positively associated with obesity. After adjusting for confounding factors, individuals in the highest quintile of ultra-processed food consumption were 32% more likely of having obesity compared to individuals in the first quintile (predicted OR = e0.005 × 56 = 1.32; 95% CI = 1.05–1.57).
Conclusion
Canadians would benefit from reducing consumption of ultra-processed foods and beverages and increasing consumption of freshly prepared dishes made from unprocessed or minimally processed foods.
Prior studies on red and processed meat consumption with breast cancer risk have generated inconsistent results. We performed a systematic review and meta‐analysis of prospective studies to summarize the evidence regarding the relation of red meat and processed meat consumption with breast cancer incidence. We searched in MEDLINE and EMBASE databases through January 2018 for prospective studies that reported the association between red meat and processed meat consumption with incident breast cancer. The multivariable‐adjusted relative risk (RR) was combined comparing the highest with the lowest category of red meat (unprocessed) and processed meat consumption using a random‐effect meta‐analysis. We identified 13 cohort, 3 nested case‐control, and 2 clinical trial studies. Comparing the highest to the lowest category, red meat (unprocessed) consumption was associated with a 6% higher breast cancer risk (pooled RR,1.06; 95% confidence intervals (95%CI):0.99‐1.14; I²=56.3%), and processed meat consumption was associated with a 9% higher breast cancer risk (pooled RR, 1.09; 95%CI, 1.03‐1.16; I²=44.4%). In addition, we identified two nested case‐control studies evaluating the association between red meat and breast cancer stratified by N‐acetyltransferase 2 acetylator genotype. We did not observe any association among those with either fast (per 25 gram/day pooled odds ratio (OR), 1.18; 95%CI, 0.93‐1.50) or slow N‐acetyltransferase 2 acetylators (per 25 gram/day pooled OR, 0.99; 95%CI, 0.91‐1.08). In the prospective observational studies, high processed meat consumption was associated with increased breast cancer risk.
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Background and aims
The Nordic diet (ND), is supposed to be associated with a reduced cardiovascular risk; however, clinical trials have led to inconsistent results regarding the effect of this diet on cardio-metabolic markers. Using systematic review and meta-analysis of randomized controlled trials (RCTs), this study aimed to investigate the effect of the ND on circulating levels of total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, and triglyceride (TG), as well as blood pressure in human adults.
Methods
PubMed, Scopus, ISI Web of Science, and Google Scholar were searched up to February 2018 for relevant articles. Random effects model was used to estimate the overall effects.
Results
Five RCTs consisting of 513 participants were included in the present review. The meta-analysis of five eligible studies showed that ND significantly reduces the total [weighted mean difference (WMD) = − 0.38 mmol/l, 95% confidence interval (CI) − 0.76, − 0.01, P = 0.044] and LDL cholesterol (WMD = − 0.30 mmol/l, 95% CI − 0.54, − 0.06, P = 0.013) levels compared with the control groups; however, none was seen for HDL cholesterol and TG levels. The meta-analysis of four eligible RCTs revealed that the ND significantly reduces the systolic (WMD = − 3.97 mmHg, 95% CI − 6.40, − 1.54, P = 0.001) and diastolic blood pressure (WMD = − 2.08 mmHg, 95% CI − 3.43, − 0.72, P = 0.003).
Conclusion
The Nordic dietary pattern improves blood pressure and also some of blood lipid markers and it should be considered as a healthy dietary pattern.
Several meta-analyses have been published summarizing the associations of the Mediterranean diet (MedDiet) with chronic diseases. We evaluated the quality and credibility of evidence from these meta-analyses as well as characterized the different indices used to define MedDiet and re-calculated the associations with the different indices identified. We conducted an umbrella review of meta-analyses on cohort studies evaluating the association of the MedDiet with type 2 diabetes, cardiovascular disease, cancer and cognitive-related diseases. We used the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist to evaluate the methodological quality of the meta-analyses, and the NutriGrade scoring system to evaluate the credibility of evidence. We also identified different indices used to define MedDiet; tests for subgroup differences were performed to compare the associations with the different indices when at least 2 studies were available for different definitions. Fourteen publications were identified and within them 27 meta-analyses which were based on 70 primary studies. Almost all meta-analyses reported inverse associations between MedDiet and risk of chronic disease, but the credibility of evidence was rated low to moderate. Moreover, substantial heterogeneity was observed on the use of the indices assessing adherence to the MedDiet, but two indices were the most used ones [Trichopoulou MedDiet (tMedDiet) and alternative MedDiet (aMedDiet)]. Overall, we observed little difference in risk associations comparing different MedDiet indices in the subgroup meta-analyses. Future prospective cohort studies are advised to use more homogenous definitions of the MedDiet to improve the comparability across meta-analyses.
Background:
The Mediterranean diet (MeDi) is considered a healthy dietary pattern, and greater adherence to this diet may improve health status. It also may reduce the social and economic costs of diet-related illnesses. This meta-review aims to summarize, synthesize and organize the effects of MeDi pattern on different health outcomes.
Methods: This meta-review was performed following the PRISMA guidelines. A systematic search was conducted in the electronic databases PubMed, Web of Science and Scopus. Two researchers screened all the records to eliminate any duplicate, and they selected the articles to be fully reviewed. A third researcher was consulted to resolve discrepancies and so reach a consensus agreement.
Results: Thirty-three articles were included, nine were systematic reviews and twenty-four were meta-analyses. Most of the diseases analysed are catalogued as non-communicable diseases (NCD), and the impact of these in populations may have major financial consequences for healthcare spending and national income. The results showed that the MeDi may improve health status, and it also may reduce total lifetime costs.
Conclusion: MeDi has been shown to be a healthy dietary pattern that may reduce risk related to NCD. The effect is larger if the pattern is combined with physical activity, and tobacco and excessive alcohol consumption are avoided. Promoting the MeDi as a healthy dietary pattern presents challenges which need the collaboration of all levels of society.
Although not always labeled as such, flexitarianism is the default lifestyle for much of the world, whereby meals based on plant materials provide the bulk of people's calories. The rich nutrition of meat and animal products is often the lynchpin of these diets, even when only consumed occasionally. It provides forms and concentrations of essential proteins, lipids, and micronutrients that are otherwise scarce. However, the production of this meat is resource intensive. It requires large quantities of arable land and water, and typically has lower conversion efficiency of farm inputs to edible outputs compared with crops, poultry, aquaculture, dairy, and eggs. An additional complication is that the quantity of ancillary products produced during slaughterhouse operations is large and underutilized. Each year, approximately 190 million metric tons (MMT) of red meat, including pork, lamb, sheep, veal, beef, and goats are produced globally, half of which will be consumed by less than 25% of the population living in developed countries. With demand for meat expected to exceed 376 MMT by 2030, an increase in the adoption of plant-based diets presents an opportunity for the world to re-evaluate how meat can be sustainably produced, with greater emphasis on animal welfare, nutritional value, product safety, better utilization, and distribution channels. In this article we consider the role meat plays in the modern diet, its production and consumption, opportunities to improve utilization of the animal, the benefits of incorporating a diverse range of red meat into diets, and the strategies that the meat industry should consider in response to flexitarianism.
Although not always labeled as such, flexitarianism is the default lifestyle for much of the world, whereby meals based on plant materials provide the bulk of people's calories. The rich nutrition of meat and animal products is often the lynchpin of these diets, even when only consumed occasionally. It provides forms and concentrations of essential proteins, lipids, and micronutrients that are otherwise scarce. However, the production of this meat is resource intensive. It requires large quantities of arable land and water, and typically has lower conversion efficiency of farm inputs to edible outputs compared with crops, poultry, aquaculture, dairy, and eggs. An additional complication is that the quantity of ancillary products produced during slaughterhouse operations is large and underutilized. Each year, approximately 190 million metric tons (MMT) of red meat, including pork, lamb, sheep, veal, beef, and goats are produced globally, half of which will be consumed by less than 25% of the population living in developed countries. With demand for meat expected to exceed 376 MMT by 2030, an increase in the adoption of plant-based diets presents an opportunity for the world to re-evaluate how meat can be sustainably produced, with greater emphasis on animal welfare, nutritional value, product safety, better utilization, and distribution channels. In this article we consider the role meat plays in the modern diet, its production and consumption, opportunities to improve utilization of the animal, the benefits of incorporating a diverse range of red meat into diets, and the strategies that the meat industry should consider in response to flexitarianism.
As western-style food systems extend further around the world, food sustainability is becoming an increasingly important issue. Such systems are not sustainable in terms of their consumption of resources, their impact on ecosystems or their effect on health and social inequality. From 2009 to 2011, the duALIne project, led by INRA and CIRAD, assembled a team of experts to investigate food systems downstream of the farm, from the farm gate, to consumption and the disposal of waste. Representing a diverse range of backgrounds spanning academia and the public and private sectors, the project aimed to review the international literature and identify major gaps in our knowledge. This book brings together its key conclusions and insights, presenting state-of-the-art research in food sustainability and identifying priority areas for further study. It will provide a valuable resource for researchers, decision-makers and stakeholders in the food industry.
Much emphasis is placed on reducing consumption of empty calories from added sugars and solid fats. Our objective was to study 30‐year trends in food and beverage sources of empty calories among US 2–18 year olds. One day of nationally representative dietary intake data for each period was examined. We categorized foods with excessive added sugars (≥13% of energy from added sugars), excessive saturated fat (≥9.1% of energy from saturated fat) or both as key sources of empty calories. All analyses use sample weights that reflect the US population aged 2–18 y. The percent of energy consumed by children and adolescents from foods and beverages classified as empty calories remained stable from 1977–2005 (80% of total energy from empty calorie foods), with a slight decrease to 76% by 2008. A concurrent decrease it total calories consumed was observed over the same time period (2003–2008). While per capita consumption decreased, the top sources of empty calories remained consistent across time, namely sugar sweetened beverages, excess fat pizza, excess fat milk beverages, excess fat processed meats, excess fat pasta dishes, excess fat poultry and excess fat cakes, cookies and pies. Substantial increases in intake were observed from 2003‐ 2008 for excess fat tortilla based dishes and cheese. These findings provide important insights on recent improvements in child diet as well as areas that can still be enhanced.
Funding comes from the Robert Wood Johnson Foundation (Grant 67506) .
Introduction:
Policymakers are interested in requiring chain restaurants to display sodium warning labels on menus to reduce sodium consumption. This study examined the influence of label design on consumers' hypothetical choices, meal perceptions, and knowledge.
Study design:
Four sequential, randomized, controlled online experiments were conducted.
Setting/participants:
Across all 4 experiments, 10,412 sociodemographically diverse participants were recruited online through Survey Sampling International and Amazon Mechanical Turk.
Intervention:
Participants were randomized to view restaurant menus with either no sodium label (control) or 1 of 13 sodium warning labels that varied the text (e.g., "sodium warning" versus "high sodium"), icons (e.g., stop sign), and colors (red/black) used. Participants placed a hypothetical meal order and rated restaurant meal perceptions. Data were collected and analyzed in 2016-2019.
Main outcome measures:
The primary outcome was sodium content of hypothetical restaurant choices. Secondary outcomes included restaurant meal perceptions and sodium knowledge.
Results:
In Experiments 1-3, all warning labels reduced average sodium ordered across both restaurants (by 19-81 mg) versus controls, with some of the largest reductions from traffic light and stop sign labels, but results were not statistically significant. In a larger, preregistered replication (Experiment 4) testing traffic light and red stop sign labels versus control, traffic light and red stop sign labels significantly reduced average sodium ordered across both restaurants (-68 mg, p=0.002 and -46 mg, p=0.049, respectively). Warnings also significantly increased participants' knowledge of sodium content and perceived health risks associated with high-sodium meals compared with no label.
Conclusions:
Traffic light and red stop sign warning labels significantly reduced sodium ordered compared with a control. Warning labels also increased knowledge about high sodium content in restaurant meals. Designs with warning text are likely to improve consumer understanding.
The big challenge of the next decades is meeting the global nutritional demand, while reducing the pressure on food resources and the GHG emissions. In this regard, the overall goal consists of redesigning the food systems and promoting sustainable dietary patterns is a crucial aspect. This article focuses on reviewing the state-of-the-art of the combined Life Cycle Assessment (LCA) and the Water–Energy–Food (WEF) Nexus approach in assessing the effects of diet transitions. Diet LCAs differ in methodology, design, and assessed environmental impacts. The WEF nexus, which aims at finding synergies and trade-offs between the water, energy, and food resources systems, has been applied to different contexts and levels. However, a limited number of nexus methods have been developed at the food and diet levels, and no commonly recognizable methodology for the nexus assessment has been achieved. An integrated LCA and WEF Nexus approach can be a decisive tool to improve the understanding of the interconnections in the nexus, as it enables the consideration of entire supply chains.
Background: The concept of ultra-processed foods (UPFs) is new, and it was proposed for the first time in 2009 as group 4 of the NOVA classification to address the degree of food processing. UPFs include not only “junk foods” but also foods marketed as healthy, such as light, vegan, organic, or gluten-free products. UPFs are characterized by the presence of highly-processed/purified “cosmetic” ingredients and/or additives to restore and/or exacerbate organoleptic properties, i.e., taste, aroma, color and texture. Substantial industrial processing techniques, e.g., puffing, extrusion cooking, and/or extreme fractioning/refining that greatly breakdown the food matrix, may also be markers of ultra-processing. The UPF concept has been consistently criticized for being an overly heterogeneous concept, and the NOVA classification has been criticized for being qualitative only and too imprecise.
Scope and approach: This review is intended to discuss the UPF concept from a holistic perspective and to analyze the scientific soundness of criticisms about UPFs and NOVA. The UPF concept is first defined; then, its primary nutritional characteristics are described, followed by their association with health based on human studies.
Key findings and conclusions: UPF criticisms differ between holistic and reductionist perspectives. In a holistic concept, reductionist researchers view the proposed definition of UPF as an imprecise, vague and heterogeneous technological group. However, from a holistic perspective, the UPF concept has serious advantages, such as broad and common deleterious health attributes (i.e., the loss of “matrix” effect, empty calories, poorly satiating, hyperglycemic and containing artificial compounds foreign to the human body).
Background: The Dietary Approaches to Stop Hypertension (DASH) diet has been associated with reduced hypertension and risk of cardiovascular diseases, nevertheless DASH diet is rich in foods that are recommended to be inversely associated with cancer risk. The objective of the present study was to conduct the first meta-analysis of studies investigating the associations between DASH diet and risk of colorectal cancer.
Methods: Relevant studies were identified in PubMed and Scopus (up to April 2019). Meta-analysis was conducted to calculate the summary relative risk (RR) estimates based on the highest versus the lowest category of DASH scores.
Results: Six articles (four prospective cohorts and two case–controls) were eligible. The pooled adjusted RR of Colorectal cancer for the highest DASH score versus the lowest category was 0.81 (95% confidence interval [CI]: 0.75–0.88).
Conclusions: Our findings suggest that adherence to the DASH diet was associated with a lower risk of colorectal cancer. These results support the need to promote healthy diet with higher intake of whole grain, vegetables, fruits, and low-fat dairy products and lower intake of salt, sweets and saturated fat to reduce colorectal cancer risk.
The metabolic syndrome is a cluster of disorders dominated by abdominal obesity, hypertriacylglycerolaemia, low HDL-cholesterol, high blood pressure and high fasting glucose. Diet modification is a safe and effective way to treat the metabolic syndrome. Dietary Approaches to Stop Hypertension (DASH) is a dietary pattern rich in fruits, vegetables and low-fat dairy products, and low in meats and sweets. DASH provides good amounts of fibre, K, Ca and Mg, and limited quantities of total fat, saturated fat, cholesterol and Na. Although DASH was initially designed for the prevention or control of hypertension, using a DASH diet has other metabolic benefits. In the present review, the effect of each dietary component of DASH on the risk factors of the metabolic syndrome is discussed. Due to limited fat and high fibre and Ca content, individuals on the DASH diet are less prone to overweight and obesity and possess lower concentrations of total and LDL-cholesterol although changes in TAG and HDL-cholesterol have been less significant and available evidence in this regard is still inconclusive. Moreover, high amounts of fruit and vegetables in DASH provide great quantities of K, Mg and fibre, all of which have been shown to reduce blood pressure. K, Mg, fibre and antioxidants have also been effective in correcting glucose and insulin abnormalities. Evidence is provided from cross-sectional investigations, cohort studies and randomised controlled trials, and, where available, from published meta-analyses. Mechanisms are described according to human studies and, in the case of a lack of evidence, from animal and cell culture investigations.
Objective
The relationship between dietary patterns and development of abdominal aortic aneurysm (AAA) is not well understood. Thus, we prospectively evaluated the association between the anti-inflammatory potential of diet and risk of AAA.
Methods
The study population included the Cohort of Swedish Men (45 072 men) and the Swedish Mammography Cohort (36 633 women), aged 45–83 years at baseline. The anti-inflammatory potential of diet was estimated using Anti-inflammatory Diet Index (AIDI) based on 11 foods with anti-inflammatory potential and 5 with proinflammatory potential (maximum 16 points) that was validated againsthigh sensitivity C reactive protein (hsCRP). Cox proportional hazard regression models were used to estimate HRs and 95% CIs. During the 14.9 years of follow-up (1 217 263 person-years), 1528 AAA cases (277 (18%) ruptured, 1251 non-ruptured) were ascertained via the Swedish Inpatient Register, the National Cause of Death Register and the Register for Vascular Surgery (Swedvasc).
Results
We observed an inverse association between the AIDI and AAA risk in women and men; HRs between extreme quartiles of the AIDI (≥8 vs ≤5 points) were 0.55 (95% CI 0.36 to 0.83) in women and 0.81 (95% CI 0.68 to 0.98) in men. The AIDI was inversely associated with both ruptured and non-ruptured AAA incidence; the HR of participants in the highest quartile of AIDI compared with those in the lowest quartile was 0.61 (95% CI 0.41 to 0.90) for ruptured AAA and 0.79 (95% CI 0.65 to 0.95) for non-ruptured AAA.
Conclusion
Adherence to diet with a high anti-inflammatory potential was associated with a reduced AAA risk, an association that was even more pronounced for AAA rupture.
Aims:
Investigations on the possible effect of the Nordic diet (ND) on the glycemic control and the risk of diabetes have led to inconsistent results. The present study tried to determine the effect of the ND on the markers of blood glucose control using a systematic review and meta-analysis of randomized controlled clinical trials (RCTs).
Methods:
Predefined keywords were used to search PubMed, ISI Web of Science, Scopus and Google Scholar up to April 2019. The random effects model was used to compute the overall estimates.
Results:
In total, six RCTs with 618 participants (6-26 weeks of follow-up period) were included in the present study. The meta-analysis revealed that the ND might not have a considerable effect on fasting blood glucose levels [weighted mean difference (WMD) = -0.05 mmol/l, 95% CI - 0.13, 0.01, P = 0.112]. In contrast, the analyses showed that the ND significantly reduces serum insulin concentrations (WMD = -1.12 mU/l, 95% CI - 1.84, - 0.39, P = 0.002) and the homeostasis model assessment for insulin resistance (HOMA-IR) (WMD = - 0.34, 95% CI - 0.53, - 0.14, P = 0.001) compared to control diets. The effect on serum insulin levels was sensitive to one of the included studies. This dietary pattern did not significantly affect 2-h post-prandial blood glucose and Matsuda index.
Conclusions:
Adherence to the ND might improve serum insulin and HOMA-IR levels; however, this effect was not confirmed for other markers of blood glucose control. Future well-designed and long-term clinical trials are highly recommended.
Objective: Several investigators have proposed a protective association between dietary approaches to stop hypertension (DASH) style diet and risk of cancers; however, they have had inconsistent results. The present study aimed to systematically review the prospective cohort studies and if possible quantify the overall effect using meta-analysis.
Methods: PubMed, Scopus, and Google Scholar were searched for cohort studies published up to July 2018. Relative risks (RRs) that were reported for fully adjusted models and their confidence intervals were extracted for meta-analysis. The random effects model was used to combine the RRs.
Results: Seventeen studies were eligible to be included in the systematic review, from which nine reports assessed the association between the DASH diet and risk of mortality from all cancer types, four assessed incidence of colorectal cancer, and two studies assessed the risk of colon and rectal cancer separately. Four studies examined the association with the incidence of other cancers (breast, hepatic, endometrial, and lung cancer). Meta-analysis showed that high adherence to DASH is associated with a decreased mortality from all cancer types (RR = 0.84, 95% confidence interval [95%CI]: 0.81–0.86). Participants with the highest adherence to the DASH diet had a lower risk of developing colorectal (RR = 0.79, 95%CI: 0.75–0.83), colon (RR = 0.80, 95%CI: 0.74–0.87), and rectal (RR = 0.84, 95%CI: 0.74–0.96) cancers compared to those with the lowest adherence.
Conclusion: DASH-style diet should be suggested as a healthy approach associated with decreased risk of cancer in the community. Prospective studies exploring the association for other cancer types and from regions other than the United States are highly recommended.
We estimate the impact on greenhouse gas emissions (GHGE) of shifting from the current average United States diet to four alternative diets that meet the 2010 Dietary Guidelines for Americans (DGA). In contrast to prior studies, which rely on process-based life-cycle-analysis GHGE estimates from the literature for particular food items, we combine a diet model, an environmentally extended input-output model of energy use in the U.S. food system, and a biophysical model of land use for crops and livestock to estimate food system GHGE from the combustion of fossil fuels and from biogenic sources, including enteric fermentation, manure management, and soil management. We find that an omnivore diet that meets the DGA while constraining cost leaves food system GHGE essentially unchanged relative to the current baseline diet (985 000 000 tons of CO 2 eq or 3191 kilograms of CO 2 eq per capita per year), while a DGA-compliant vegetarian and a DGA-compliant omnivore diet that minimizes energy consumption in the food system reduce GHGE by 32% and 22%, respectively. These emission reductions were achieved mainly through quantity and composition changes in the meat, poultry, fish; dairy; and caloric sweeteners categories. Shifting from current to healthy diets as defined by the DGA does not necessarily reduce GHGE in the U.S. food system, although there are diets, including two presented here and by inference many others, which can achieve a reduction in GHGE.
Objective
To evaluate the association between ultra-processed food intake and all-cause mortality and CVD mortality in a nationally representative sample of US adults.
Design
Prospective analyses of reported frequency of ultra-processed food intake in 1988–1994 and all-cause mortality and CVD mortality through 2011.
Setting
The Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994).
Participants
Adults aged ≥20 years ( n 11898).
Results
Over a median follow-up of 19 years, individuals in the highest quartile of frequency of ultra-processed food intake (e.g. sugar-sweetened or artificially sweetened beverages, sweetened milk, sausage or other reconstructed meats, sweetened cereals, confectionery, desserts) had a 31% higher risk of all-cause mortality, after adjusting for demographic and socio-economic confounders and health behaviours (adjusted hazard ratio=1·31; 95% CI 1·09, 1·58; P -trend = 0·001). No association with CVD mortality was observed ( P -trend=0·86).
Conclusions
Higher frequency of ultra-processed food intake was associated with higher risk of all-cause mortality in a representative sample of US adults. More longitudinal studies with dietary data reflecting the modern food supply are needed to confirm our results.
Objective:
Vegetarian diets are consistently associated with improved health outcomes, and higher diet quality may contribute to improved health outcomes. This systematic review aims to qualitatively compare the a priori diet quality of vegetarian and nonvegetarian diets.
Methods:
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, 2 online databases (Web of Science and PubMed) were searched for English language studies comparing diet quality among vegetarian and nonvegetarian adults using an a priori diet quality index. Two reviewers assessed study eligibility. Comparisons were made between total and component (when available) diet quality scores among the 12 studies meeting inclusion criteria.
Conclusions:
Lacto-ovo vegetarians or vegans had higher overall diet quality (4.5-16.4 points higher on the Healthy Eating Index 2010 [HEI-2010]) compared with nonvegetarians in 9 of 12 studies. Higher HEI-2010 scores for vegetarians were driven by closer adherence to recommendations for total fruit, whole grains, seafood and plant protein, and sodium. However, nonvegetarians had closer adherence to recommendations for refined grains and total protein foods. Higher diet quality in vegetarian diets may partially explain improvements in health outcomes compared with nonvegetarians; however, more research controlling for known confounders like health consciousness is needed.
Background & aims:
There is a large body of evidence which supports the role of inflammation in the pathophysiology of mental health disorders, including depression. Dietary patterns have been shown to modulate the inflammatory state, thus highlighting their potential as a therapeutic tool in disorders with an inflammatory basis. Here we conduct a systematic review and meta-analysis of current literature addressing whether there is a link between the inflammatory potential of a diet and risk of depression or depressive symptoms.
Methods:
A systematic literature search was performed to identify studies that reported an association between the inflammatory potential of the diet and risk of depressive symptoms or diagnosis of depression. Random effect models were used to meta-analyse effect sizes. Quality assessment, publication bias, sensitivity and subgroup analyses were also performed.
Results:
Eleven studies, with a total of 101,950 participants at baseline (age range: 16-72 years old), were eligible for review. A significant association between a pro-inflammatory diet and increased risk of depression diagnosis or symptoms was evident, relative to those on an anti-inflammatory diet (OR: 1.40, 95% confidence intervals: 1.21-1.62, P < 0.001). No publication bias was detected;