Changes in terms of risks/benefits of shifting diets towards healthier and more sustainable dietary models

Abstract

Abstract Food production and therefore human diet are identified as important sources of environmental impact. Unhealthy and unsustainable diets with high intake of meat and low intake of plant‐based products are predominant worldwide. On the other hand, a balance between health and sustainability is necessary, since diets that are environmentally sustainable could lack essential macro‐ and micronutrients and result in nutrient deficiencies, non‐communicable diseases and malnutrition. The aim of this project was to investigate the nutritional adequacy and environmental impact of adults' diet by comparing current dietary habits and new alternative dietary scenarios. First, a systematic review was conducted following PRISMA guidelines to assess the environmental impact of current diets and sustainable dietary scenarios such as vegan, vegetarian, pescatarian, omnivorous and optimised dietary patterns worldwide. In the second part of the project, an optimisation study was conducted, based on a multi‐objective optimisation approach, with the purpose of creating the optimal diet based on nutritional and environmental constraints for the adult Italian population. The dietary scenarios of the optimised models were developed in accordance with the Italian food‐based dietary guidelines. Food consumption data was extracted from the INHES study and used as baseline diet. A clear evaluation of the current environmental impact because of diet and potential sustainable dietary scenarios globally is challenging. Finally, national food‐based guidelines should be adjusted by suggesting healthy and sustainable dietary recommendations in line with traditional eating habits and local food availability in order the desirable dietary shifts towards sustainability to be feasible.

Full text

EU-FORA SERIES 5
APPROVED: 31 August 2022
doi: 10.2903/j.efsa.2022.e200904
Changes in terms of risks/benefits of shifting diets towards
healthier and more sustainable dietary models
Aliki Kalmpourtzidou, Beatrice Biasini, Alice Rosi, Michele Donati and Francesca Scazzina
University of Parma, Parma, Italy
Abstract
Food production and therefore human diet are identified as important sources of environmental
impact. Unhealthy and unsustainable diets with high intake of meat and low intake of plant-based
products are predominant worldwide. On the other hand, a balance between health and sustainability
is necessary, since diets that are environmentally sustainable could lack essential macro- and
micronutrients and result in nutrient deficiencies, non-communicable diseases and malnutrition. The
aim of this project was to investigate the nutritional adequacy and environmental impact of adults’diet
by comparing current dietary habits and new alternative dietary scenarios. First, a systematic review
was conducted following PRISMA guidelines to assess the environmental impact of current diets and
sustainable dietary scenarios such as vegan, vegetarian, pescatarian, omnivorous and optimised
dietary patterns worldwide. In the second part of the project, an optimisation study was conducted,
based on a multi-objective optimisation approach, with the purpose of creating the optimal diet based
on nutritional and environmental constraints for the adult Italian population. The dietary scenarios of
the optimised models were developed in accordance with the Italian food-based dietary guidelines.
Food consumption data was extracted from the INHES study and used as baseline diet. A clear
evaluation of the current environmental impact because of diet and potential sustainable dietary
scenarios globally is challenging. Finally, national food-based guidelines should be adjusted by
suggesting healthy and sustainable dietary recommendations in line with traditional eating habits and
local food availability in order the desirable dietary shifts towards sustainability to be feasible.
Keywords: dietary scenarios, food sustainability, environmental impact, alternative diets, dietary
patterns
Correspondence: eu-fora@efsa.europa.eu
EFSA Journal 2022;20(S2):e200904www.efsa.europa.eu/efsajournal
© 2022 European Food Safety Authority. EFSA Journal published by Wiley-VCH GmbH on behalf of
European Food Safety Authority.

Declarations of interest: If you wish to access the declaration of interests of any expert
contributing to an EFSA scientific assessment, please contact interestmanagement@efsa.europa.eu.
Acknowledgements: This report is funded by EFSA as part of the EU-FORA programme.
Suggested citation: Kalmpourtzidou A, Biasini B, Rosi A, Donati M and Scazzina F, 2022. Changes in
terms of risks/benefits of shifting diets towards healthier and more sustainable dietary models. EFSA
Journal 2022;20(S2):e200904, 8 pp. https://doi.org/10.2903/j.efsa.2022.e200904
ISSN: 1831-4732
This is an open access article under the terms of the Creative Commons Attribution-NoDerivs License,
which permits use and distribution in any medium, provided the original work is properly cited and no
modifications or adaptations are made.
The EFSA Journal is a publication of the European Food Safety
Authority, a European agency funded by the European Union.
The environmental impact of current and alternative diets
www.efsa.europa.eu/efsajournal 2 EFSA Journal 2022;20(S2):e200904
© 2022 European Food Safety Authority. EFSA Journal published by Wiley-VCH GmbH on behalf of
European Food Safety Authority.

Table of contents
Abstract........................................................................................................................................................ 1
1. Introduction..................................................................................................................................... 4
2. Description of work programme ........................................................................................................ 4
2.1. Aims................................................................................................................................................ 4
2.2. Activities/methods ............................................................................................................................ 4
2.2.1. Systematic review ............................................................................................................................ 4
2.2.2. Optimisation study ........................................................................................................................... 5
3. Conclusions...................................................................................................................................... 5
3.1. General conclusions of the project results .......................................................................................... 5
3.2. Scientific activities of the fellowship ................................................................................................... 6
3.2.1. Optimisation course.......................................................................................................................... 6
3.2.2. Poster presentation .......................................................................................................................... 6
3.2.3. Conferences and webinars (Table 1) .................................................................................................. 6
3.3. Additional information....................................................................................................................... 7
References.................................................................................................................................................... 7
Abbreviations ................................................................................................................................................ 8
The environmental impact of current and alternative diets
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1. Introduction
Due to the technological innovations in agricultural sector, food availability and security have
increased significantly. As a result, hunger, undernutrition, poverty and mortality have been reduced
through the last years worldwide (Myers et al., 2017; Willett et al., 2019). However, diets with low
vegetable, fruit, wholegrain and high in red and processed meat intake are dominant worldwide
(Springmann et al., 2018; Kalmpourtzidou et al., 2020). As a result, high-calorie diets and animal-
based protein sources have a negative impact both on health and environment (Heller et al., 2013;
Willett et al., 2019; Grosso et al., 2020). Food production is responsible for the one-third of global
greenhouse gas emissions (GHGEs) on the planet (Whitmee et al., 2015; Myers et al., 2017; Crippa
et al., 2021). The nutritional and economic transition in low- and middle-income countries contributed
largely to the double burden of malnutrition and high environmental impact of diets in these countries
(Gill et al., 2015; Miller et al., 2016; Batal et al., 2018; Kalmpourtzidou et al., 2020). Therefore, a
dietary shift to alternative, more sustainable choices is necessary.
According to Food Agriculture Organization (FAO), sustainable diets are defined as ‘those diets with
low environmental impacts which contribute to food and nutrition security and to healthy life for
present and future generations’(FAO, 2010). EAT-Lancet Commission defined global targets for
sustainable diets and food systems taking into consideration environmental, nutritional and health
factors (Willett et al., 2019). Even though the planetary health diet proposed by EAT-Lancet
Commission could have a positive effect both on health and the environment, the eating habits,
traditions and food availability of each country are taken into account, separately (Willett et al., 2019).
Numerous studies in the last years have been conducted with the aim to evaluate the effect of the
current diets and alternative diets on the environment and health. Vegetarian, Mediterranean and the
New Nordic diet are some of the dietary patterns that could be considered sustainable (Aleksandrowicz
et al., 2016).
Consequently, the main goal of the specific project, as part of the European Food Risk Assessment
(EU-FORA) fellowship programme was initially to systematically review the environmental impact of the
current diets and alternative diets worldwide. Based on these results, the current Italian diet was
optimised by minimising its GHGEs and meeting the national food-based dietary guidelines (FBDGs)
and the National Recommended Energy and Nutrient Intake Levels (LARN) proposed by the Italian
Society of Human Nutrition (SINU).
2. Description of work programme
2.1. Aims
The aim of this project was to investigate the nutritional adequacy and environmental impact of
adults’diet by comparing current dietary habits and new alternative dietary scenarios. To this purpose,
firstly a systematic review and afterwards an optimisation study were conducted. The systematic
review aimed to understand and analyse the sustainability of current diets worldwide in comparison to
alternative diets in relation to their environmental impact. The objective of the optimisation study was
to build optimal sustainable dietary models for the adult Italian population using the current Italian
diet as baseline diet and taking into consideration the Italian FBDGs and LARN.
2.2. Activities/methods
2.2.1. Systematic review
In the first part of the project, a systematic review was conducted following PRISMA guidelines to
assess the environmental impact of current population diets and alternative sustainable dietary
scenarios such as vegan, vegetarian, pescatarian, flexitarian, including optimised dietary patterns
worldwide. Scopus, Web of Sciences and Pubmed were searched for available data from October 2021
to January 2022. The key strings were adjusted based on the database searched. Only original studies,
conducted and published from 2000 onwards, in English language, quantitatively assessing the
nutritional and environmental impact of dietary patterns in healthy adult populations, were included.
The environmental impact of current and alternative diets
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2.2.2. Optimisation study
The analysis of health and environmental impact of more sustainable diets have been widely
investigated in the last years in Europe (Laine et al., 2021). However, the attempts to optimise the
Italian diet have been performed based on the last National Food consumption Survey INRAN-SCAI
2005–2006 (Leclercq et al., 2009), which does not represent the current dietary habits in Italy.
Therefore, to allow a better reliability of the optimisation study, the use of food consumption data from
the INHES study has been considered a preferable solution to better represent the most recent food
consumption in Italian population (Pounis et al., 2017). In INHES, adults older than 18 years were
recruited and 24-h recalls were collected for the food consumption assessment. The EFSA Food
classification and description system for exposure assessment (FoodEx2) (EFSA, 2017) was applied for
the extraction of food consumption data (Pounis et al., 2017).
The optimisation modelling was based on the multi-objective optimisation approach proposed by
Donati et al. (2016). Specifically, a linear programming model was developed, and constraints related
to the nutrients requirements per age and sex based on LARN (SINU, 2014), the frequency of food
groups consumption based on the Italian FBDGs, alternative plant-based protein food products,
acceptability and environmental impact indicators were applied. The nutritional constraints have been
drawn up taking into account daily energy requirements distinguishing between men and women, and
the different sources of energy. The model incorporated restrictions on energy and macronutrients
according to LARN recommendations. The optimal combination of food products was obtained
minimising the environmental impact and specifically the GHGEs of the diet. The objective functions
were represented algebraically as follows:
1. Nutrients intake:
∑
i
∑
j
foodi,jai,k ≥lowk8k,
∑
i
∑
j
foodi,jai,k ≤uppk8k,
where food
i,j
: food item i of food category j; a
i,k
: coefficients of energy and macronutrients k per gram
of food i; low
k
and upp
k
: lower and upper level of nutrients, respectively.
2. FBDGs recommendations:
∑
i
foodi,j ≤portj1þ0:10ðÞ8j,
where port
j
: portion associated with each food category.
3. GHGEs minimisation:
min
foodi,j ≥0MEM ¼∑
i
∑
j
foodi,jemi,
where MEM: minimise carbon dioxide with food item specific impact em
i
(CO
2
emissions).
3. Conclusions
3.1. General conclusions of the project results
The results of the studies included in the systematic review vary within and in-between countries
regarding the environmental impact of current and alternative diets. Ideally, common methodology
regarding current food consumption and environmental impact assessment should be used to have
comparable and harmonised results. Optimised dietary models have a lower CO
2
footprint, especially
diets identified as sustainable or sustainable and healthy, than dietary scenarios based on literature.
Comparing current diets to sustainable and health scenarios/models created per country, meat and
dairy products consumption should decrease, while fruit, vegetable, fish and egg consumption should
increase. National nutrition surveys instead of food supply/purchase or FAOSTAT food balance sheets
should be used as baseline diets for the constructions of more sustainable and healthy scenarios to
avoid the overestimation of current food consumption. Additionally, available data derived mainly from
high-income countries, thus low- and middle-income countries are underrepresented. In order to have
The environmental impact of current and alternative diets
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a holistic overview of the environmental impact of the diets, further research is needed and should
target low- and middle-income countries. Finally, the construction of optimal sustainable diets is
complex. Multiple constraints need to be considered to propose diets being healthy, nutritious,
acceptable, affordable, and environmentally sustainable for the general population.
3.2. Scientific activities of the fellowship
3.2.1. Optimisation course
The fellow followed the course ‘Economical modelling and environmental policies’, part of the MSc
programme ‘Sciences and technologies for environment and resources’of the University of Parma,
taught by Professor Michele Donati. The knowledge of the construction of mathematical programming
models and the use of related programming tools, such as the General Algebraic Modelling System
(GAMS), helped the fellow to understand the optimisation modelling methodology for the construction
of the sustainable optimal dietary models.
3.2.2. Poster presentation
The fellow made a poster presentation at the National Conference Italian Society of Human
Nutrition 2022 that took place in Naples, Italy. Part of the results of the systematic review were
presented. Current diets and alternative dietary scenarios and their environmental impacts in South
Europe were the main focus.
3.2.3. Conferences and webinars (Table 1)
Table 1: Conferences and webinars followed by the fellow
Title Type of
activity Organiser/Tutor Date
Towards the Future of Food: the Cultured Meat
between Food Safety, Sustainability and Public
Perception
Webinar University of Parma 27/9/2021,
10.00–13.00 CET
Sustainable and Healthy Diets
Webinar 1: Introducing the concept and context
of sustainable healthy diets
Webinar 2: Current policies and global initiatives
on sustainable and healthy diets
Webinar 3: Revision of current Food Based
Dietary Guidelines and policy required
Webinar 4: The food cycle: from farming and
sourcing to packaging and food waste
Webinar 5: Applying Sustainability in Dietetic
Practice
Webinar series EFAD 16/9/2021–31/5/
2022
Climate Change, biodiversity and nutrition:
promoting healthy diets from efficient, inclusive,
resilient and sustainable food systems
WHO Side
Event at Pre-
COP26
FAO 10 January 2021,
14:00–15.30 CEST
Alimentazione e tumori (Nutrition and tumors) Conference SINU 22/10/2021,
9.00–13.00 CET
Life Cycle Assessment for sustainability food
systems: integrating nutritional and
environmental assessment
Webinar FAO 27/10/2021,
9.30–10.30 CEST
EAT-GlobeScan Consumer Research on a
Sustainable Food System
Webinar EAT 29/10/2021,
Achieving Healthy Diets from Sustainable Blue
Food Systems in Small Island Developing States
WHO Side
Event at
COP26
WHO 11 February 2021,
18:00–19:00 CET
Changing Behaviour: From Policy to table.
Moving the Dial towards Healthy Sustainable
diets
E-symposium Alpro Foundation 17/11/2021,
14:00–16:20 CET
The environmental impact of current and alternative diets
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3.3. Additional information
Manuscripts reporting detailed results of the systematic review and the optimisation study are in
preparation and will be submitted to peer-reviewed journals. Publications will follow after the end of
the fellowship programme.
References
Aleksandrowicz L, Green R, EJM J, Smith P and Haines A, 2016. The impacts of dietary change on greenhouse gas
emissions, land use, water use, and health: a systematic review. PLOS ONE, 11(11), e0165797. Available
online: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165797
Batal M, Steinhouse L and Delisle H, 2018. The nutrition transition and the double burden of malnutrition.
Medecine et sante tropicales, 28(4), 345–350. Available online: https://pubmed.ncbi.nlm.nih.gov/30799815/
Crippa M, Solazzo E, Guizzardi D, Monforti-Ferrario F, Tubiello FN and Leip A, 2021. Food systems are responsible
for a third of global anthropogenic GHG emissions. Nature Food, 2, 198–209. Available online: https://www.
nature.com/articles/s43016-021-00225-9
Donati M, Menozzi D, Zighetti C, Rosi A, Zinetti A and Scazzina F, 2016. Towards a sustainable diet combining
economic, environmental and nutritional objectives. Appetite, 106, 48–57.
EFSA (European Food Safety Authority). The food classification and description system FoodEx 2 (revision 2). EFSA
Supporting Publications 2015;EN-804, 90 pp. https://doi.org/10.2903/sp.efsa.2015.EN-804
FAO (Food Agriculture Organization), 2010. Sustainable diets and biodiversity.
Gill M, Feliciano D, Macdiarmid J and Smith P, 2015. The environmental impact of nutrition transition in three case
study countries. Food Security, 7, 493–504 Available online: https://link.springer.com/article/10.1007/s12571-
015-0453-x
Grosso G, Fres´
an U, Bes-rastrollo M, Marventano S and Galvano F, 2020. Environmental impact of dietary choices:
role of the Mediterranean and other dietary patterns in an italian cohort. International Journal of Environmental
Research and Public Health, 17, 1468.
Heller MC, Keoleian GA and Willett WC, 2013. Toward a life cycle-based, diet-level framework for food
environmental impact and nutritional quality assessment: a critical review. Environmental Science &
Technology, 47, 12632–12647. Available online: https://pubmed.ncbi.nlm.nih.gov/24152032/
Kalmpourtzidou A, Eilander A and Talsma EF, 2020. Global vegetable intake and supply compared to
recommendations: a systematic review. Nutrients, 12, 1558.
Laine JE, Huybrechts I, Gunter MJ, Ferrari P, Weiderpass E, Tsilidis K, Aune D, Schulze MB, Bergmann M, Temme
EHM, Boer JMA, Agnoli C, Ericson U, Stubbendorff A, Ibsen DB, Dahm CC, Deschasaux M, Touvier M, Kesse-
Guyot E, S´
anchez P´
erez MJ, Rodr´
ıguez Barranco M, Tong TYN, Papier K, Knuppel A, Boutron-Ruault MC,
Mancini F, Severi G, Srour B, K ¨
uhn T, Masala G, Agudo A, Skeie G, Rylander C, Sandanger TM, Riboli E and
Vineis P, 2021. Co-benefits from sustainable dietary shifts for population and environmental health: an
assessment from a large European cohort study. The Lancet Planetary Health, 5, e786–e796.
Leclercq C, Arcella D, Piccinelli R, Sette S and le Donne C, 2009. The Italian National Food Consumption Survey
INRAN-SCAI 2005-06: main results in terms of food consumption. Public Health Nutrition, 12(12), 2504–2532.
Available online: https://pubmed.ncbi.nlm.nih.gov/19278564/
Title Type of
activity Organiser/Tutor Date
Shifting our food systems to support sustainable
eating for climate and public health
E-symposium Oatly 12 September
2021, 14:00–18:15
CET
Vivi l’esperienza sostenibile (Live the sustainable
experience)
Conference SINU 14/12/2021, 9.00–
17.30 CET
XLII National Conference Italian Society of
Human Nutrition (SINU) 2022
Conference SINU 04–4 June 2022
How can chefs help to save the planet? Discover
the Life Climate Smart Chefs project
Webinar Barilla Foundation 24/5/2022, 16:00–
17:30 CET
Fruit and Vegetables for Sustainable Healthy
Diets (FRESH)
Webinar IFPRI 25/5/2022, 15:30–
17:00 CET
Why consider soy alternatives to dairy and meat:
Building a healthy, sustainable diet
Webinar Alpro Foundation, Fuji
Foundation for Protein
research
14/6/2022, 9.00–
11.30 CET
One Health Conference 2022 Conference EFSA 21–24/06/2022
The environmental impact of current and alternative diets
www.efsa.europa.eu/efsajournal 7 EFSA Journal 2022;20(S2):e200904

Miller V, Yusuf S, Chow CK, Dehghan M, Corsi DJ, Lock K, Popkin B, Rangarajan S, Khatib R, Lear SA, Mony P, Kaur
M, Mohan V, Vijayakumar K, Gupta R, Kruger A, Tsolekile L, Mohammadifard N, Rahman O, Rosengren A,
Avezum A, Orlandini A, Ismail N, Lopez-Jaramillo P, Yusufali A, Karsidag K, Iqbal R, Chifamba J, Oakley SM,
Ariffin F, Zatonska K, Poirier P, Wei L, Jian B, Hui C, Xu L, Xiulin B, Teo K and Mente A, 2016. Availability,
affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the
Prospective Urban Rural Epidemiology (PURE) study. Lancet Glob Health, 4, e695–e703. Available online:
https://pubmed.ncbi.nlm.nih.gov/27567348/
Myers SS, Smith MR, Guth S, Golden CD, Vaitla B, Mueller ND, Dangour AD and Huybers P, 2017. Climate change
and global food systems: potential impacts on food security and undernutrition. Annual Review of Public
Health, 20(38), 259–277.
Pounis G, Bonanni A, Ruggiero E, di Castelnuovo A, Costanzo S, Persichillo M, Bonaccio M, Cerletti C, Riccardi G,
Donati MB, de Gaetano G, Iacoviello L and INHES Investigators, 2017. Food group consumption in an Italian
population using the updated food classification system FoodEx2: results from the Italian Nutrition & HEalth
Survey (INHES) study. Nutrition, Metabolism and Cardiovascular Diseases, 27, 307–328. Available online:
https://pubmed.ncbi.nlm.nih.gov/28274729/
SINU (Italian Society of Human Nutrition). Livelli di Assunzione di Riferimentodi Nutrienti ed energiaper la
popolazione italianaIV Revisione. 2014.
Springmann M, Wiebe K, Mason-D’Croz D, Sulser TB, Rayner M and Scarborough P, 2018. Health and nutritional
aspects of sustainable diet strategies and their association with environmental impacts: a global modelling
analysis with country-level detail. Lancet Planet Health, 2, e451–e461. Available online: https://pubmed.ncbi.
nlm.nih.gov/30318102/
Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, Ezeh A, Frumkin H, Gong P, Head P, Horton
R, Mace GM, Marten R, Myers SS, Nishtar S, Osofsky SA, Pattanayak SK, Pongsiri MJ, Romanelli C, Soucat A,
Vega J and Yach D, 2015. Safeguarding human health in the Anthropocene epoch: report of the Rockefeller
Foundation-Lancet Commission on planetary health. The Lancet, 386, 1973–2028.
Willett W, Rockstr ¨
om J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A,
Jonell M, Clark M, Gordon LJ, Fanzo J, Hawkes PC, Zurayk R, Rivera JA, De Vries W, Sibanda LM, Afshin A,
Chaudhary A, Herrero M, Agustina R, Branca F, Lartey A, Fan S, Crona B, Fox E, Bignet V, Troell M, Lindahl T,
Singh S, Cornell SE, Reddy KS, Narain S, Nishtar S and Murray CJL, 2019. Food in the Anthropocene: the EAT–
Lancet Commission on healthy diets from sustainable food systems. The Lancet, 393, 447–492. Available
online: http://www.thelancet.com/article/S0140673618317884/fulltext
Abbreviations
EFAD European Federation of the Associations of Dietitians
EU-FORA European Food Risk Assessment
FAO Food Agriculture Organization
FBDGs food-based dietary guidelines
GHGEs greenhouse gas emissions
IFPRI International Food Policy Research Institute
INHES the Italian Nutrition and Health Survey
LARN Livelli di Assunzione di Riferimento di Nutrienti ed energia (National
Recommended Energy and Nutrient Intake Levels)
SINU Societ`
a Italiana di Nutrizione Umana (Italian Society of Human Nutrition)
WHO World Health Organization
The environmental impact of current and alternative diets
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