Changing dietary patterns is necessary to improve the sustainability of Western diets from a One Health perspective

Together towards sustainable dining - Cocreating behavioral change interventions with restaurants

Behavioral change interventions in restaurants towards sustainable food choices are a promising avenue towards attaining climate goals. In this research, we investigated how these interventions can successfully be implemented in a restaurant context to promote sustainable food choices. In a multiple-year co-creation project with 32 restaurants and consultant chefs, we provided knowledge on sustainable meal preparation and on using behavioral interventions, collaborated to design suitable interventions for the individual restaurants, and tested these interventions in a mixed methods approach. We provided support from researchers and consultant chefs throughout this process. The four restaurants that ultimately implemented an intervention were all successful in increasing uptake of their sustainable menu options. While participants' overall support and enthusiasm for knowledge of sustainability interventions was high, especially towards more sustainable meal preparation, many restaurants dropped out of the project. Despite using a time- and resource-intensive approach, it remained difficult to overcome both psychological barriers (no perceived responsibility and the sense of already "doing enough") as well as practical hurdles (fear of customers' response and lack of time) for restaurants. As implementation of the co-created solutions proved very challenging, future research on interventions promoting sustainable food choices should therefore specifically focus on taking away practical barriers. Possible avenues for doing so are focusing on more sustainable meal preparation, involving customers in cocreation, and a greater focus on the responsibility of the sector in culinary and hospitality education to instill sustainable habits there, which are then more easily practiced when working in the field.

Assessing the One Health (ecosystem, animal and human health) impacts of current dietary patterns based on farm-to-fork life cycle assessment in the Republic of Ireland

Food production and dietary patterns play a central role in the myriad interactions among human, animal, and environmental health, emphasising the need for a One Health approach, and this study aims to evaluate dietary patterns within this framework. A cross-sectional dietary survey of adults was undertaken (2021) with a sample size of 957 respondents, representative of the population of Ireland. Subsequently, a farm-to-fork life cycle assessment (LCA) was employed to assess nine human health and environmental impacts (fine particulate matter formation, freshwater and marine ecotoxicity and eutrophication, human carcinogenic and non-carcinogenic toxicity and terrestrial acidification and ecotoxicity) across thirteen distinct dietary patterns: total population, rural, urban, omnivore, flexitarian, pescatarian, vegetarian, vegan, 'meat-focused', 'dairy/ovo-focused', 'vegetable-focused', 'seafood-focused', and 'potato-focused', employing the daily weight of consumed food (g/per capita/day) as the functional unit. Results indicate the 'meat-focused' diet exhibited the highest impact for fine particulate matter formation (8.00 × 10-3 kg PM2.5 eq person-1 day-1), marine eutrophication (6.60 × 10-3 kg N eq person-1 day-1), and terrestrial acidification (0.054 kg SO2 eq person-1 day-1). The 'seafood-focused' diet had the highest impact on freshwater (0.056 kg 1,4-DCB person-1 day-1) and marine ecotoxicity (0.069 kg 1,4-DCB person-1 day-1), freshwater eutrophication (8.36 × 10-4 kg P eq person-1 day-1), and human carcinogenic toxicity (0.144 kg 1,4-DCB person-1 day-1). In comparison, the 'potato-focused' diet exhibited the highest human non-carcinogenic (6.87 kg 1,4-DCB person-1 day-1) and terrestrial ecotoxicity (2.01 kg 1,4-DCB person-1 day-1). Transitioning from the "mean" diet to a vegan diet showed the highest percent decrease across all nine impacts (60.4 % - 107.3 %), followed by the 'vegetable-focused' diet (28.5 % - 66.2 %). Findings indicate adopting sustainable diets-'vegetable-focused', vegetarian, and vegan-can improve human, environmental, and animal health; however, trade-offs should be considered. Effective consumer communication and policies can enhance awareness of the interconnectedness of diets within the One Health framework, supporting both environmental and health goals.

Childhood Obesity: A Narrative Review

Obesity among children has emerged as a worldwide health issue due to childhood obesity becoming a pandemic, and it is often linked to various illnesses, fatal outcomes, and disability in adulthood. Obesity has become an epidemic issue in both developed and developing countries, particularly among youngsters. The most common factors contributing to non-communicable diseases (NCDs) are unhealthy eating habits, desk-bound games, avoidance of physical activity-requiring activities, smoking, alcohol usage, and other added items. All these factors increase NCDs, including obesity, resulting in various morbidities and early death. Additionally, childhood obesity has psychological, emotional, cognitive, societal, and communicative effects. For example, it raises the possibility of issues related to physical appearance, self-esteem, confidence level, feelings of isolation, social disengagement, stigma, depression, and a sense of inequality. Children who consume more energy-dense, high-fat, low-fiber-containing food than they need usually store the excess as body fat. Standardizing indicators and terminology for obesity-related metrics is critical for better understanding the comparability of obesity prevalence and program effectiveness within and between countries. The underlying variables must be altered to reduce or avoid harm to the target organ in children. As a result, reducing childhood obesity is a considerable public health goal for the benefit of society and the long-term well-being of individuals.

Spatio-temporal Dynamics of Water Footprints of Food Consumption in South Korea: A Decomposition Analysis

South Korea faces severe water stress, as classified by the OECD, with changing dietary patterns significantly impacting water resources. To ensure water conservation and food security, it is crucial to understand the driving factors of the water footprint of food consumption (WFC). This study examined the WFC in South Korea from 2007 to 2023, focusing on how dietary choices impact water use and sustainability, and identified the key driving factors of changes in WFC. Using the logarithmic mean Divisia index (LMDI), this study decomposed these drivers into water footprint intensity, dietary structure, average dietary intake per person, and population effect. Additionally, global and local spatial autocorrelation analyses were used to measure the degree of spatial aggregation and distribution of WFC across administrative units. Results revealed a significant increase in WFC, from 27.6 km3 in 2007 to 34.7 km3 in 2023, with an average annual growth of 2%. Among the drivers, water footprint intensity contributed most to the increase in WFC, while average dietary intake per person led to a decrease. Cereals, meats and fish collectively account for more than 76% of the total WFC during the study period. The findings suggest that the drivers influencing the changes in WFC vary across administrative units, underscoring the need for tailored policies and strategies to promote sustainable food consumption practices that could conserve water resources in each administrative unit.

Environmental sustainability of diets among children and adolescents in the German DONALD cohort study: age and time trends, and nutrient adequacy

BACKGROUND

Identifying diets beneficial for both human and planetary health has become increasingly important. However, to date, there is limited research on sustainable diets for children and adolescents, a vulnerable population group with specific nutritional needs.

OBJECTIVES

We aimed to identify 1) the main determinants; 2) age and time trends of greenhouse gas emissions (GHGE), land use (LU), and water use (WU) of diets of children and adolescents; and 3) analyze the associations of dietary GHGE, LU, and WU with nutrient adequacy.

METHODS

A total of 5510 3-d-weighted dietary records (n = 856; 6-17 y; 48% ♀) of the DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) study between 2000 and 2021 were analyzed. Values of GHGE (kgCO2eq), LU (m2 × year), and WU (L) determined by life cycle assessment were assigned to all recorded foods. For nutrient adequacy, the mean adequacy ratio (MAR = ∑(nutrient intake / recommended intake) / number of nutrients) was used. Data were analyzed using polynomial mixed-effects regression models.

RESULTS

The main contributors to GHGE and LU were meat products (GHGE: 25.6%; LU: 32.8%), dairy products (22.2%; 17.7%), and sweets and pastries (14.0%; 14.3%); to WU, nonalcoholic beverages (24.3%), meat products (18.9%), and vegetables and fruits (17.7%). GHGE, LU, and WU per 1000 kcal increased with age (P < 0.01). GHGE and LU per 1000 kcal increased between 2000 and 2010 and decreased after that in females (P < 0.01) and males (GHGE only: P = 0.02). No significant time trend was found for WU (P > 0.05). A higher MAR was directly associated with GHGE/1000 kcal (MAR: β: 0.011, 95% CI: 0.008, 0.013, P < 0.0001), LU/1000 kcal (MAR: β: 0.009, 95%CI: 0.005, 0.013, P < 0.0001), and WU/1000 kcal (MAR: β: 0.429, 95% CI: 0.325, 0.533, P < 0.0001).

CONCLUSIONS

Our findings underscore the further need and the capacity for change toward more environmentally sustainable diets. Yet, the tradeoff between environmental sustainability and nutrient adequacy in the diets of children and adolescents requires specific attention to dietary composition.

Review of Diet Quality Indices that can be Applied to the Environmental Assessment of Foods and Diets

PURPOSE OF REVIEW

The aim was to identify indices of diet quality and health that could be applied to the environmental assessment of foods in order to provide metrics that collectively assess nutritional, health and environmental dimensions.

RECENT FINDINGS

The review identified five major groups of indices: nutrient-food quantity-based; guideline-based; diversity-based; nutrient quality-based; health-based. Nutrient-food quantity-based and guideline type indices were the most frequently used to evaluate diet quality. Scaled assessment using a nutritional functional unit is the most common integration of diet quality with the environmental analysis of foods. There are fewer indices that measure the heath impacts of foods, but epidemiological dietary risk factors seem a promising approach to integrate diet and health impacts into the environmental assessment of foods. Five groups of nutritional and health indices were identified that can be applied when performing an environmental assessment of foods. This review proposes different methodological insights when doing such assessments to ensure transparency and comparability of the results.

Spatial Barriers to Transforming toward a Healthy Food System in the Noreste of Mexico

In the past five decades, global food systems have undergone a notable transition, moving from predominantly rural settings to increasingly urban and industrialized environments, largely driven by processes of globalization and supply chain integration. However, this evolution has not adequately addressed equitable access to nutritious diets and food environments, resulting in adverse health outcomes. This study delves into the spatial and non-spatial barriers that impede the adoption of healthy diets in the Noreste of Mexico, particularly focusing on the challenges associated with accessing and cultivating plant-based foods. Through an examination of suitable areas for urban agriculture and an exploration of the socio-cultural factors influencing the adoption of plant-based diets, the research focuses on interventions aimed at promoting healthier and more sustainable eating practices in Monterrey. The findings of the study reveal significant disparities in food access across the Monterrey metropolitan area, with central urban zones exhibiting superior access to fresh foods compared to suburban and peripheral regions. This inequality disproportionately affects marginalized areas characterized by higher poverty rates, exacerbating issues of food insecurity. Nevertheless, traditional dietary practices could offer promising avenues for creating culturally significant and healthier dietary transitions, even amidst the ongoing process of urbanization.

Changes in eating habits and lifestyle during the first year of the COVID-19 pandemic across metropolitan regions in Brazil and Germany: A survey-based cross-sectional study

COVID-19 caused profound societal changes to cope rapidly with the new circumstances. The food market changed its quantity, quality, form, and frequency dynamics. Consequently, food-eating habits and lifestyles like physical exercise likely experienced changes. An online-based survey was conducted between June 2020 and January 2021 in the metropolitan regions of Rhine Ruhr Metropolis (RRM), Greater São Paulo (GSP), other metropolitan regions in São Paulo state (oMRSP), other Brazilian metropolitan regions (oBRMR), and the remaining urban areas in both countries (oUA), representing different contexts of Brazil and Germany. We assessed self-reported changes in physical activity level, diet quality, self-reported eating habits, and buying groceries during the first year of the pandemic. In Germany, indoor and outdoor activities increased for 34% of the respondents, while in Brazil, there was a decrease in physical activity for 50% of the participants. The Healthy Eating Index (HEI) scored higher among Brazilians (16.8) than Germans (15.2) on a 0-29 HEI scale. Increased awareness of healthy and sustainable eating habits was observed in GSP (0.7), oMRSP (0.63), oBRMR (0.7), and oUA (0.68) on a scale from no change (0) to change (1). In RRM, an increase in convenience foods was noticed (0.86). Participants reported discomfort with food purchasing due to hygiene measures and avoided going to the supermarket (0.7 on average in Brazil and 0.58 for females using the same 0-1 scale). Also, food supply at the grocery shops was reported to be often unavailable and in lower quantities. A real-time assessment of self-reported changes in eating habits and lifestyle during the lockdown in 2020 in different contexts is insightful for rethinking strategies to improve conditions in the post-COVID-19 era and prepare for future pandemics.

Relationship between consumption of high fat, sugar or sodium (HFSS) food and obesity and non-communicable diseases

The objective of this study was to investigate the relationship between high in fat, sugar or salt consumption, obesity and non-communicable diseases (NCDs) in the population in Thailand, and other associated factors. This study used data from participants age 15 years or older from the 2021 Health Behaviour of Population Survey. The final analytical sample included 74 894 respondents with complete data. Binary logistic regression analysis was used to investigate the relationship between socio-demographic characteristics, unhealthy food, NCDs and obesity. People with obesity had the significant ORs for sugar-sweetened beverages or SSB (OR 1.208; 95% CI 1.159 to 1.259), high-fat foods (OR 1.162; 95% CI 1.120 to 1.207) and snacks (OR 1.048; 95% CI 1.004 to 1.093), but had the significant protective ORs for meat products (OR 0.964; 95% CI 0.930 to 0.999), instant food (OR 0.903; 95% CI 0.865 to 0.942) and fast food (OR 0.871; 95% CI 0.831 to 0.913). People with any NCDs had the significant protective ORs for meat products (p≤0.001), instant food (p≤0.05) and fast food (p≤0.01). People with diabetes tended not to drink SSB while people with heart disease tended not to consume SSB and snacks. The findings suggest a need for prevention and control strategies such as promoting healthy snacking behaviour, modifying food environments and paying specific attention to the population most at risk of obesity and NCDs.

Legumes: A Vehicle for Transition to Sustainability

Legumes are an excellent source of protein and have been used in the human diet for centuries. Consumption of legumes has been linked to several health benefits, including a lower risk of cardiovascular diseases, type 2 diabetes mellitus, and certain types of cancer, while legumes' high fiber content promotes digestive health. Aside from the positive health benefits, one of the most significant advantages of legumes is the low environmental footprint of their cultivation. They can be grown in a variety of climates and soil types, and they require less water and fertilizer than other crops, making them a sustainable option for farmers. Thanks to their nutritional and physicochemical properties, they are widely used by the food industry since the growing popularity of plant-based diets and the increasing demand for alternatives to meat offers the opportunity to develop legume-based meat substitutes. As the use of legumes as a source of protein becomes widespread, new market opportunities could be created for farmers and food industries, while the reduction in healthcare costs could have a potential economic impact. Achieving widespread adoption of legumes as a sustainable source of protein requires coordinated efforts by individuals, governments, and the private sector. The objective of this narrative review is to present the benefits coming from legume consumption in terms of health and environmental sustainability, and underline the importance of promoting their inclusion in the daily dietary pattern as well as their use as functional ingredients and plant-based alternatives to animal products.

The SHED Index: A Validation Study to Assess Sustainable HEalthy Diets in Portugal

This study aims to adapt and validate the Sustainable HEalthy Diet (SHED) Index for the Portuguese adult population, which was developed to assess sustainable and healthy eating patterns. Data were collected using a web-based questionnaire administered through interviews with 347 individuals aged between 18 and 65 years old. The SHED Index evaluates 30 items, allowing for the assessment and scoring of sustainable and healthy eating patterns. The higher the SHED Index score, the more sustainable and healthier the diet. A semi-quantitative food frequency questionnaire was used to assess the participants' dietary intake. The criterion validity was examined by testing the relationship between the SHED Index score and adherence to the Mediterranean Diet. Reproducibility was assessed by determining agreement and reliability with test-retest. Construct validity was confirmed based on established criteria. A higher SHED Index score was associated with moderate to high adherence to the Mediterranean diet, while it was inversely related to the proportion of animal-sourced foods in the overall food intake (r = -0.281, p < 0.001). Good reliability and agreement were found for the SHED Index score. Our findings suggest that the SHED Index is a valid and reliable tool for assessing sustainable and healthy diets in the Portuguese adult population.

Feeding climate and biodiversity goals with novel plant-based meat and milk alternatives

Plant-based animal product alternatives are increasingly promoted to achieve more sustainable diets. Here, we use a global economic land use model to assess the food system-wide impacts of a global dietary shift towards these alternatives. We find a substantial reduction in the global environmental impacts by 2050 if globally 50% of the main animal products (pork, chicken, beef and milk) are substituted-net reduction of forest and natural land is almost fully halted and agriculture and land use GHG emissions decline by 31% in 2050 compared to 2020. If spared agricultural land within forest ecosystems is restored to forest, climate benefits could double, reaching 92% of the previously estimated land sector mitigation potential. Furthermore, the restored area could contribute to 13-25% of the estimated global land restoration needs under target 2 from the Kunming Montreal Global Biodiversity Framework by 2030, and future declines in ecosystem integrity by 2050 would be more than halved. The distribution of these impacts varies across regions-the main impacts on agricultural input use are in China and on environmental outcomes in Sub-Saharan Africa and South America. While beef replacement provides the largest impacts, substituting multiple products is synergistic.

Promoting and disseminating consistent and effective nutrition messages: challenges and opportunities

Nutrition messages are a central part of policy making as well as communication via product information, advertising, healthcare advice and lifestyle campaigns. However, with amplified information (and misinformation) from a growing number of sources, inconsistent and conflicting food landscapes, and limited engagement from the public, nutrition messaging tensions have become more accentuated than previously. In this review, we focus on the challenges facing those wishing to effect dietary change through communication; and identify opportunities and future research questions. Beginning with a new working definition and taxonomy for the term ‘nutrition message’, we consider the evolution of public health nutrition messages from the past century and discuss which types of messages may be more effective. We then turn to the challenges of implementation and highlight specific barriers to recipients' understanding and change. While the evidence has many gaps and there is a need for systematic evaluation of nutrition messages, research indicates that recipients are more likely to act on fewer messages that provide clear benefits and which resonate with their perceived health needs, and which are relatively straightforward to implement. Effectiveness may be improved through consideration of how nutrition messages can be designed to complement key non-health drivers of food choice (taste, cost) and societal/cultural norms. Consistency can be achieved by aligning the wider food and messaging environment to desired public health actions; that is by ensuring that retail settings provide and signpost healthier choices, and that mass media nutrition messages work with, not against, public health advice.

Association between an Anti-Inflammatory Dietary Score and Periodontitis-Evidence from the Population-Based Hamburg City Health Study

While the effects of dietary patterns on cardiovascular risk and diabetes have been well studied, the evidence is scarce as to which diet has the greatest anti-inflammatory potential and how dietary patterns are associated with periodontitis. In the Hamburg City Health Study (HCHS), we developed an anti-inflammatory dietary score using a data-driven approach based on the relationship of relevant selected food groups with inflammatory biomarkers (hsCRP and IL-6). The aim of this cross-sectional study was to evaluate the association between the anti-inflammatory dietary score and the incidence of periodontitis in Hamburg, Germany. A total of n = 5642 participants fit the required inclusion criteria and were selected for analysis. Periodontal disease was assessed using probing depth, gingival recession, and bleeding on probing. Dietary intake was measured using a food frequency questionnaire (FFQ). A self-developed anti-inflammatory dietary score served as the key explanatory variable. Higher scores reflected lower inflammatory processes (measured through the biomarkers hsCRP and IL-6). Several covariates were included in the regression analysis. Regressions revealed that a higher anti-inflammatory dietary score was significantly associated with lower odds to be affected by periodontal disease in an unadjusted model (OR 0.86, 95% CI 0.82-0.89, p < 0.001) and in an adjusted model (age, sex, smoking, diabetes, hypertension, and physical activity) (OR 0.93, 95% CI 0.89-0.98, p = 0.003). Our study demonstrated a significant inverse association between an anti-inflammatory dietary score and periodontitis. Individuals with higher intake of proinflammatory nutrition should be specifically addressed to avoid periodontitis.

Toward One Health: a spatial indicator system to model the facilitation of the spread of zoonotic diseases

Recurrent outbreaks of zoonotic infectious diseases highlight the importance of considering the interconnections between human, animal, and environmental health in disease prevention and control. This has given rise to the concept of One Health, which recognizes the interconnectedness of between human and animal health within their ecosystems. As a contribution to the One Health approach, this study aims to develop an indicator system to model the facilitation of the spread of zoonotic diseases. Initially, a literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify relevant indicators related to One Health. The selected indicators focused on demographics, socioeconomic aspects, interactions between animal and human populations and water bodies, as well as environmental conditions related to air quality and climate. These indicators were characterized using values obtained from the literature or calculated through distance analysis, geoprocessing tasks, and other methods. Subsequently, Multi-Criteria Decision-Making (MCDM) techniques, specifically the Entropy and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods, were utilized to combine the indicators and create a composite metric for assessing the spread of zoonotic diseases. The final indicators selected were then tested against recorded zoonoses in the Valencian Community (Spain) for 2021, and a strong positive correlation was identified. Therefore, the proposed indicator system can be valuable in guiding the development of planning strategies that align with the One Health principles. Based on the results achieved, such strategies may prioritize the preservation of natural landscape features to mitigate habitat encroachment, protect land and water resources, and attenuate extreme atmospheric conditions.

Freeze-Dried Cooked Chickpeas: Considering a Suitable Alternative to Prepare Tasty Reconstituted Dishes

The current trend in food consumption is toward convenience, i.e., fast food. The present work aims to study the potential of incorporating freeze-dried cooked chickpeas into a complex and traditional dish in Spanish gastronomy, such as Cocido, which has this legume as the main ingredient. Cocido is a two-course meal: a thin-noodle soup and a mix of chickpeas, several vegetables, and meat portions. The textural properties, sensory qualities, and rehydration kinetics of chickpeas of three Spanish varieties were investigated to select the most suitable cooking conditions to obtain freeze-dried chickpeas of easy rehydration whilst maintaining an adequate sensory quality for the preparation of the traditional dish. The sensory quality of various vegetables and meat portions, cooked under different conditions, was evaluated after freeze-drying and rehydration. It was possible to reproduce the sensory quality of the traditional dish after rehydration with water, heating to boiling in a microwave oven for 5 min, and resting for 10 min. Therefore, it is possible to commercialize complex dishes based on pulses and other cooked and freeze-dried ingredients as reconstituted meals with a wide nutrient profile. Nevertheless, additional research is required on the shelf life, together with other economic and marketing issues such as design of a proper packaging, that would allow consumption as a two-course meal.

Perspective: Plant-Based Meat Alternatives Can Help Facilitate and Maintain a Lower Animal to Plant Protein Intake Ratio

The health and environmental advantages of plant-predominant diets will likely lead to increasing numbers of consumers reducing their reliance on animal products. Consequently, health organizations and professionals will need to provide guidance on how best to make this change. In many developed countries, nearly twice as much protein is derived from animal versus plant sources. Potential benefits could result from consuming a higher share of plant protein. Advice to consume equal amounts from each source is more likely to be embraced than advice to eschew all or most animal products. However, much of the plant protein currently consumed comes from refined grains, which is unlikely to provide the benefits associated with plant-predominant diets. In contrast, legumes provide ample amounts of protein as well other components such as fiber, resistant starch, and polyphenolics, which are collectively thought to exert health benefits. But despite their many accolades and endorsement by the nutrition community, legumes make a negligible contribution to global protein intake, especially in developed countries. Furthermore, evidence suggests the consumption of cooked legumes will not substantially increase over the next several decades. We argue here that plant-based meat alternatives (PBMAs) made from legumes are a viable alternative, or a complement, to consuming legumes in the traditional manner. These products may be accepted by meat eaters because they can emulate the orosensory properties and functionality of the foods they are intended to replace. PBMAs can be both transition foods and maintenance foods in that they can facilitate the transition to a plant-predominant diet and make it easier to maintain. PBMAs also have a distinct advantage of being able to be fortified with shortfall nutrients in plant-predominant diets. Whether existing PBMAs provide similar health benefits as whole legumes, or can be formulated to do so, remains to be established.

Environmental and health-related external costs of meat consumption in Italy: estimations and recommendations through life cycle assessment

The literature on the external costs of food consumption is limited. This study aims at advancing in this field by translating the environmental and health-related impacts generated by the life-cycle of meat into external costs via monetization. The main types of meat consumed in Italy are used as a case study. The potential external costs are estimated via attributional life cycle assessment (LCA), using: i) the ReCiPe method for the environmental impact assessment (fourteen impact categories), ii) the population attributional fractions for the health damage from meat ingestion, and iii) the CE Delft environmental prices for monetization. Results show that processed pork and beef generate the highest costs on society, with an external cost of approximately 2€ per 100 g. Fresh pork and poultry follow, with a cost of 1€ and 0.5€ per 100 g, respectively. For comparison, the potential external costs of legumes (i.e., a plant-based alternative to meat) are estimated to be from eight to twenty times lower than meat (around 0.05€ per 100 g of legumes). In 2018, meat consumed in Italy potentially generated a cost on society of 36.6 bn€. The burden arises almost equally from impacts generated before meat ingestion (mainly associated with the emissions arisen from farming), and after the ingestion (due to diseases potentially associated with meat consumption). A sensitivity analysis on the main parameters revealed a large uncertainty on the final yearly cost, ranging from 19 to 93 bn€. Although more research is needed to improve the accuracy and the validity of the models used in the study (e.g., human health impact assessment, monetization) and to include potential external costs currently unaccounted for (e.g., water use, animal welfare, occupational health), results show unequivocal significant costs associated with meat consumption. We thus advocate for policies aimed at reducing these costs and allocating them properly.

European dietitians as key agents of the green transition: An exploratory study of their knowledge, attitudes, practices, and training

Introduction

How food systems are currently provisioning food to the population is a matter of debate worldwide. Food systems, driven by widespread and increasing adherence to a westernized dietary pattern, are failing to meet people's basic needs and are draining natural resources. There is a push to make food systems more healthy, fair, and sustainable. To this end, action from all players is needed to meet the international agenda. In this regard, dietitians play a crucial role, as they can provide advice and promote actions that foster the adoption of more sustainable dietary patterns (SDP) as well as the promotion of sustainable food systems. As an emerging requirement in their training, it is crucial to know what dietitians know about SDP as well as their attitudes and current practices in this field in order to strengthen their competences and be key agents for the green transition. For this reason, the aim of the present study is to explore the knowledge, attitudes, practices, and training (KAPT) of European dietitians on SDP by administering an online survey.

Methods

Cross-sectional survey administered between April-August 2021 to dietitians based in the European countries with National Dietetic Associations or Education Associate Members affiliated to the European Federation of Associations of Dietitians (EFAD). Results were analyzed based on European region of professional practice (Northern/Southern/Western/South-East Europe), area of expertise and years of experience.

Results

Responses from 2211 dietitians from 25 countries were received, although the analysis was based on those that responded at least 90% of the survey (n=208). European dietitians are lacking training on SDP but are willing to learn more about it. Most dietitians perceive themselves as able to define an SDP, although aspects concerning social and economic sustainability were underestimated. Dietitians concur that barriers exist to the promotion of SDP, such as the lack of updated national food-based dietary guidelines and the absence of support from peers and managers. The country of professional activity seemed to be key to influencing dietitians' KAPT.

Discussion

These results emphasize the need to strengthen European dietitians' training in SDP and increase public/private commitment to consider dietitians as key professionals for the transition towards SDP.

Advancing the quantitative characterization of farm animal welfare

Animal welfare is usually excluded from life cycle assessments (LCAs) of farming systems because of limited consensus on how to measure it. Here, we constructed several LCA-compatible animal-welfare metrics and applied them to data we collected from 74 diverse breed-to-finish systems responsible for 5% of UK pig production. Some aspects of metric construction will always be subjective, such as how different aspects of welfare are aggregated, and what determines poor versus good welfare. We tested the sensitivity of individual farm rankings, and rankings of those same farms grouped by label type (memberships of quality-assurance schemes or product labelling), to a broad range of approaches to metric construction. We found farms with the same label types clustered together in rankings regardless of metric choice, and there was broad agreement across metrics on the rankings of individual farms. We found woodland and Organic systems typically perform better than those with no labelling and Red tractor labelling, and that outdoor-bred and outdoor-finished systems perform better than indoor-bred and slatted-finished systems, respectively. We conclude that if our goal is to identify relatively better and worse farming systems for animal welfare, exactly how LCA welfare metrics are constructed may be less important than commonly perceived.

The Environmental Sustainability of Plant-Based Dietary Patterns: A Scoping Review

BACKGROUND

A large part of the existential threat associated with climate change is the result of current human feeding patterns. Over the last decade, research evaluating the diet-related environmental impacts of plant-based diets has emerged, and a synthesis of the available data is now due.

OBJECTIVES

The objectives of the study were as follows: 1) to compile and summarize the literature on diet-related environmental impacts of plant-based dietary patterns; 2) to assess the nature of the data on impacts of plant-based dietary patterns on both environmental parameters and health (e.g., if land use is reduced for a particular diet, is cancer risk also reduced?); and 3) to determine where sufficient data exist for meta-analyses, in addition to identifying gaps within the literature.

METHODS

Global peer-reviewed studies on the environmental impacts of plant-based diets were searched in Ovid MEDLINE, EMBASE, and Web of Science. After removing duplicates, the screening identified 1553 records. After 2 stages of independent review by 2 reviewers, 65 records met the inclusion criteria and were eligible to be used in synthesis.

RESULTS

Evidence suggests that plant-based diets may offer lower greenhouse gas emissions (GHGEs), land use, and biodiversity loss than offered by standard diets; however, the impact on water and energy use may depend on the types of plant-based foods consumed. Further, the studies were consistent in demonstrating that plant-based dietary patterns that reduce diet-related mortality also promote environmental sustainability.

CONCLUSIONS

Overall, there was agreement across the studies regarding the impact of plant-based dietary patterns on GHGE, land used, and biodiversity loss despite varied plant-based diets assessed.

Assessing the interlinkage between biodiversity and diet through the Mediterranean diet case

The adoption of healthy and sustainable diets, and the transition to sustainable food systems is of principal importance in order to counteract the double burden of climate change and non-communicable diseases. The Mediterranean diet (MD) has been widely recognized as a biodiversity and healthy nutrition resource to support sustainable development and food security. This study explored biodiversity in terms of food plants species, subspecies, varieties and races, and also addressed food-plant diversity differences between the MD and western-type consumption patterns. It was funded by the EU BioValue Project, aiming to promote the integration of underutilized crops into the food value chains. Using a two-stage scheme, data were selected from MEDUSA and Euro+Med databases (including 449 species, 2,366 subspecies, varieties, and races). Furthermore, 12 countries from North Africa and Europe were classified in two groups according to their sub-regional attributes and their traditionally most prevalent dietary pattern (MD or western-type diets). Statistical analysis showed that the mean of the majorly cultivated food plants in the MD was significantly higher than its counterpart in the Western-diet. Furthermore, no statistical difference was detected in the averages of native food plants between the MD group and the Western diet group, implying that the higher diversity in food plants observed in the MD seems to be attributed to crop utilization rather than crop availability. Our findings indicated the interlinkage between biodiversity and prevailing dietary patterns, and further underlined that biodiversity could constitute a prerequisite for dietary diversity, and hence nutrition security. In addition, this study demonstrated that diets and nutrition should be approached in a broader way within the context of both agro-food and ecological systems.

Environmental Impact of Two Plant-Based, Isocaloric and Isoproteic Diets: The Vegan Diet vs. the Mediterranean Diet

Food consumption is one of the major causes of climate change, resource depletion, loss of biodiversity, and other kinds of environmental impact by modern households. According to evidence, a global change in dietary habits could be the single most effective and rapid intervention to reduce anthropic pressure on the planet, especially with respect to climate change. Our study applied Life Cycle Assessment (LCA) to investigate the total environmental impact of two plant-based diets: the Mediterranean and the Vegan diets, according to relevant Italian nutritional recommendations. The two diets share the same macronutrient rates and cover all the nutritional recommendations. Calculations were made on the basis of a theoretical one-week 2000 kcal/day diet. According to our calculations, the Vegan diet showed about 44% less total environmental impact when compared to the Mediterranean diet, despite the fact that the content of animal products of the latter was low (with 10.6% of the total diet calories). This result clearly supports the concept that meat and dairy consumption plays a critical role, above all, in terms of damage to human health and ecosystems. Our study supports the thesis that even a minimal-to-moderate content of animal foods has a consistent impact on the environmental footprint of a diet, and their reduction can elicit significant ecological benefits.

Identifying Future Study Designs for Mental Health and Social Wellbeing Associated with Diets of a Cohort Living in Eco-Regions: Findings from the INSUM Expert Workshop

Diets influence our mental health and social wellbeing (MHSW) in multiple ways. A rising community concept, Eco-Regions, has gained interest. The research project "Indicators for assessment of health effects of consumption of sustainable, organic school meals in Ecoregions" (INSUM) aims to develop future-oriented research approaches to measure the potential health effects of more sustainable and healthy diets. This first part of the project focuses on MHSW with the goal to identify suitable study designs and indicators. The methodology is based on a 2-day workshop with an interdisciplinary group of experts. This paper describes commonly applied research methods on the nexus between diet and MHSW as presented by the experts and summarises key points from the discussions. The results show that the dominating tool to investigate MSHW is questionnaires. Questionnaires vary largely depending on the research design, such as participants or distribution channels. Cohort studies addressing families and including in-depth interventional and/or experimental studies may be suitable for an Eco-Region investigation. Those MHSW studies can be conducted and combined with measurements of somatic health effects. We conclude that indicators should be seen as complementary rather than independent. Explorative research designs are required to investigate complex Eco-Regions.

Nutritionally adequate and environmentally respectful diets are possible for different diet groups: an optimized study from the NutriNet-Santé cohort

BACKGROUND

Research has shown that vegetarian diets have a low environmental impact, but few studies have examined the environmental impacts and nutritional adequacy of these diets together, even though vegetarian diets can lead to nutritional issues.

OBJECTIVES

Our objective was to optimize and compare 6 types of diets with varying degrees of plant foods (lacto-, ovolacto-, and pescovegetarian diets and diets with low, medium, and high meat content) under nutritional constraints.

METHODS

Consumption data in 30,000 participants were derived from the French NutriNet-Santé cohort using an FFQ. Diets were optimized by a nonlinear algorithm minimizing the diet deviation while meeting multiple constraints at both the individual and population levels: nonincrease of the cost and environmental impacts (as partial ReCiPe accounting for greenhouse gas emissions, cumulative energy demand, and land occupation, distinguishing production methods: organic and conventional), under epidemiologic, nutritional (based on nutrient reference values), and acceptability (according to the diet type) constraints.

RESULTS

Optimized diets were successfully identified for each diet type, except that it was impossible to meet the EPA (20:5n-3) + DHA (22:6n-3) requirements in lacto- and ovolactovegetarians. In all cases, meat consumption was redistributed or reduced and the consumption of legumes (including soy-based products), whole grains, and vegetables were increased, whereas some food groups, such as potatoes, fruit juices, and alcoholic beverages, were entirely removed from the diets. The lower environmental impacts (as well as individual indicators) observed for vegetarians could be attained even when nutritional references were reached except for long-chain n-3 (omega-3) fatty acids.

CONCLUSIONS

A low-meat diet could be considered as a target for the general population in the context of sustainable transitions, although all diets tested can be overall nutritionally adequate (except for n-3 fatty acids) when planned appropriately.This trial was registered at clinicaltrials.gov as NCT03335644.

A Comparison of the Mediterranean Diet and Current Food Patterns in Italy: A Life Cycle Thinking Approach for a Sustainable Consumption

The transition toward more sustainable food systems, which already represents a central element of the European Farm to Fork and Green Deal strategies, could be an effective measure to contribute to global decarbonization and greenhouse gas (GHGs) reduction goals; concurrently, it could improve the health status and nutrition of the global population. In this context, the Mediterranean diet (MD) could play a considerable role, as it is generally recognized as a more balanced, healthy, and sustainable eating pattern than Western consumption patterns, which are characterized by excess food and high energy content, thus causing undesirable effects on both human health and the environment. Although traditionally linked to MD, Italy sees relatively moderate adherence by its citizens, as they consume about +75% of the daily caloric intake recommended by MD. Therefore, this study aims to quantitatively assess the potential environmental, economic, and health impacts of this lower adherence to MD by Italians. Current Italian Food Patterns (CIFP) in 2019 were analyzed and compared to the MD recommended amounts through a Life Cycle Thinking (LCT) approach (LCA) and carbon footprint (CF) analysis. The results show that CIFP, compared to MD, has +133% greater impacts on the environmental macro-area, +100% greater impacts on the human health macro-area, and +59% greater impacts on the economic macro-area (with annual fossil and mineral resource savings of $53.35 per person, $3.2 billion per year). The analysis also shows that CIFP has a CF of 6.54 × 101 kg CO2 eq, +142% over MD (2.7 × 101 kg CO2 eq), resulting in a lower environmental impact of the Mediterranean diet.

Insights into Circular Horticulture: Knowledge Diffusion, Resource Circulation, One Health Approach, and Greenhouse Technologies

The integration of the circular economy in agriculture has promoted sustainable innovation in food production systems such as horticulture. The present paper illustrates how horticulture is transitioning to the circular economy. This research field's performance approaches and trends were assessed through a bibliometric and text-mining analysis of the literature. Our findings revealed that circular horticulture is a recent research field that is constantly growing. Its approach has been neither systemic nor integrative but fragmented. Bioeconomy, urban agriculture, recycled nutrients, biochar, fertigation, and desalination have been positioned as research hotspots. Vegetables and fruits are the most studied crops. Resource circulation has focused primarily on biowaste recovery to provide benefits such as biofertilizers and linear-substrate substitutes, and on water reuse for the establishment of hydroponic systems. The One Health approach is scarcely explored and, therefore, weakly articulated, wherein the absence of assessment methodologies encompassing the health of ecosystems, animals, and people is a notable limitation. Science-policy interfaces between One Health and food systems need to be improved. Lastly, greenhouse technologies are aligned with bioenergy, sustainable materials, and sensing technologies. Challenges and directions for future research have been raised to promote the redesign of horticultural production systems, integrating long-term circularity.

Consensus-building around the conceptualisation and implementation of sustainable healthy diets: a foundation for policymakers

BACKGROUND

Healthy and sustainable diets need to be adopted to reduce the negative impact of food consumption on human and planetary health. Food systems account for a third of greenhouse gas emissions. "Dietary Patterns for Health and Sustainability" is a World Health Organization (WHO) project that aims to build consensus among international food, health, and sustainability experts and policymakers on how to conceptualise healthy and sustainable diets and on the actions and policies that could be implemented in the WHO European Region to promote these diets.

METHODS

A qualitative study among European food, health, and sustainability experts and policymakers to elicit their views on multiple dimensions of food sustainability and health was carried out using a three-phase process, including semi-structured interviews, a Nominal Group Technique, and focus groups during a participatory WHO workshop held in Copenhagen. Thematic analysis was used to analyse the three data sources.

RESULTS

The workshop resulted in a shared understanding of the interconnected components of sustainable healthy eating habits. As a result of this understanding, a variety of potential solutions were identified, including actions across different policy domains, tools, strategic guidelines, needs, and pathways for sustainable healthy diets. The pathways included the need for a multi-stakeholder approach, as well as the simultaneous execution of an aligned and coherent mix of policies at the local and national levels.

CONCLUSIONS

The prioritised actions should be aimed at helping government policymakers promote sustainable healthy diets and make decisions on improving dietary patterns for citizens' health and wellbeing in line with the United Nations Sustainable Development Goals in the European Region.