Sustainable food profiling models to inform the development of food labels that account for nutrition and the environment: a systematic review

Towards Personalised Nutrition in Major Orthopaedic Surgery: Elements of Care Process

With the spread of enhanced recovery protocols, the management of the perioperative pathway of patients undergoing major orthopaedic surgery has been harmonised to these international standards. A natural evolution of the enhanced recovery framework is to integrate personalised pathways of care for those with unique needs, thus addressing inter-individual differences. Personalised nutrition is the practice of attributing a personal imprint to the perioperative nutritional support and has the potential to ensure more effective and equitable care for those patients who may require more than standard support. The authors of this opinion article review each important element of personalisation with respect to their coverage of what is important in the perioperative care of major orthopaedic procedures such as hip and knee replacement.

Testing the effect of ecolabels on the environmental impact of food purchases in worksite cafeterias: a randomised controlled trial

BACKGROUND

Reducing the environmental impact of foods consumed is important for meeting climate goals. We aimed to conduct a randomised controlled trial to test whether ecolabels reduce the environmental impact of food selected in worksite cafeterias, alone or in combination with increased availability of more sustainable meal options.

METHODS

Worksite cafeterias (n = 96) were randomised to one of three study groups, with 54 included for final analysis. One group was intended to increase the availability of meat-free options, but no change was implemented. Therefore, this group was treated as part of the control, creating two groups: (1) control (no ecolabels) (n = 35), and (2) ecolabels (n = 19). Regression analysis assessed the primary outcome of total environmental impact of hot meals sold over a 6-week period. Secondary outcome analyses explored the individual environmental indicators that composed the total environmental impact score (i.e., greenhouse gas emissions, biodiversity loss, eutrophication, and water scarcity). The mean weekly environmental impact scores of hot meal options over the full 12-week trial period were assessed using hierarchical mixed effects models.

RESULTS

There was no significant effect of the intervention on the environmental impact scores of meals sold (mean difference between control and intervention sites: -1.4%, 95%CI: -33.6%, + 30.8%). There was no evidence of an effect in mean weekly environmental impact score (-5.4%, 95%CI: -12.6%, + 2.5%), nor in any of the four individual environmental indicators (greenhouse gas emissions: -3.6%, 95%CI: -30.7%, 34.3%; biodiversity loss: 2.0%, 95%CI: -25.8%, 40.2%; eutrophication: -2.4%, 95%CI: -29.3%, 34.7%; water scarcity: -0.4%, 95%CI: -28.7%, 39.1%).

CONCLUSIONS

Ecolabels may not be an effective tool to shift consumer behaviour in worksite cafeterias towards meals with lower environmental impact.

TRIAL REGISTRATION

The study was pre-registered prospectively on ISRCTN ( https://www.isrctn.com/ISRCTN10268258 ; 06/01/2022).

Food-based indices for the assessment of nutritive value and environmental impact of meals and diets: A systematic review protocol

Current food production and consumption practices are impacting both human and planetary health. Though these challenges are multifaceted, shifting to healthy dietary choices from sustainable food systems is one solution. Food-based labelling is a common public-health strategy aimed at influencing consumption practices, primarily displaying front-of-pack nutrition labelling to encourage healthier choices. Due to the dual impact of food on human and planetary health there is a growing need to additionally include environmental impact information. However, this potentially conflicting information could overwhelm consumers, necessitating a simplified approach that combines both nutritive and environmental values. Previous work has identified existing models, termed sustainable food profiling models, for labelling of individual food products based on their environmental impacts and nutritive value. Foods are rarely eaten in isolation and are often consumed as composite meals, which aggregate to diets. Therefore, it is important to identify indices that exist to assess or rank meals and diets according to their nutritional and environmental impacts. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 01 May 2024 (PROSPERO registration ID = CRD42024537149). In the present protocol the methodology to identify and review existing food-based indices for the assessment of nutritive value and environmental impact of meals and diets and their intended public health purpose is described. Our primary research questions are: (i) what food-based indices assessing nutritive value and environmental impact exist for classification or ranking of meals or diets? and (ii) what are the methods used to create, and the key characteristics of, these indices?. The results are expected to increase understanding of, and highlight the variation in, the creation of combined measures for the assessment of nutritive value and environmental impact for meals and diets. Additionally, findings can be used to inform researchers, business, and policy actors on future approaches for labelling foods, meals, or diets in a way that supports healthy and sustainable meal choices and diets.

Shaping sustainable consumption: Quebec consumers' knowledge and beliefs about the environmental impacts of food

There is growing evidence that shifts in food consumption have the potential to mitigate the environmental impacts of food systems. Yet, although Canadians are increasingly concerned about climate change, changes towards more sustainable food consumption patterns are not widely observed. Understanding consumers' perspective on these issues is crucial for bridging this gap between individual behaviors and collective concerns. This study explores the knowledge, understanding and beliefs of Quebec consumers regarding the environmental impacts of food and their potential for shaping sustainable food consumption. A representative sample of consumers (N = 978) answered an online questionnaire assessing their factual knowledge and investigating their views of food systems impacts. Results indicate low levels of knowledge and highlight widely shared beliefs regarding food systems. Consumers tended to overestimate the role of transport in food's environmental footprint and believe that reducing transport or eating local foods are the most effective ways to improve environmental sustainability. Likewise, consumers tend to underestimate the impact of production, as well as solutions that could effectively reduce this impact. The findings reveal a need for improved literacy and awareness of the environmental impacts of food, thereby highlighting the importance of effective information and education strategies to shape sustainable food consumption habits.

Strengths and weaknesses of food eco-labeling: a review

Food labeling is increasingly expanding and adding more information to the food package. There is strong evidence about nutrition labeling effectiveness in driving food choice, especially if displayed in the front of package (FoP). Despite the growing attention to nutrition and sustainable diets, few countries have implemented sustainable labels or eco-labels that could address economic, social and/or environmental concerns. Implementing new techniques of eco-labeling emerges as a consumer-focused solution. However, evidence of the effectiveness of eco-labeling in driving consumers' choices is heterogeneous and not univocal. Thus, this review aims to summarize the evidence about the effectiveness of FoP eco-labeling in driving food choice and provide a reference framework of the eco-labeling initiatives relative to food package labeling. This narrative review addresses both the potential benefits as well as the main concerns that arise from the use of eco-labels. Although eco-labeling seems to provide a series of sustainability benefits for producers and consumers, the implementation of such policies should take into consideration potential trade-offs and inter-sectorial coordination to obtain bigger impacts, assuming that a policy itself cannot transform the whole food system. Eco-labeling could be encouraged and implemented within a set of policies shaping sustainable food systems.

Policy Insights from High-Income Countries to Guide Safe, Nutritious, and Sustainable Alternative Proteins for Low- and Middle-Income Countries

The United Nations has encouraged governments to promote sustainable healthy diets to address undernutrition, obesity, and climate change. This perspective paper examines policy insights from selected high-income countries in Asia, Europe, and North America to understand how traditional and novel alternative proteins (AP) may support sustainable healthy diets in low- and middle-income countries (LMIC) where populations experience malnutrition in all forms. AP products must be affordable, locally sustainable, and culturally acceptable to improve diet quality and health. Food-based dietary guidelines are a policy tool to guide AP product formulation, manufacturing, processing, labeling, and marketing to ensure that these products complement traditional plant- and animal-source proteins in sustainable healthy diets. This paper suggests that a new food categorization taxonomy is needed to guide AP product recommendations. Decision-makers must harmonize multisectoral policies to ensure LMIC populations have access to sustainable healthy diets to achieve a protein transition and food systems transformation by 2050.

What Is the Likely Impact of Alternative Proteins on Diet Quality, Health, and the Environment in Low- and Middle-Income Countries

Alternative protein (AP) foods are proposed to support a global protein transition. Whereas AP food innovation has been a strategy to promote consumption of protein sources with low environmental impact in high-income countries (HICs) diets, their relation to sustainable, high-quality diets in low- and middle-income countries (LMICs) remains to be established. AP foods vary in nutrient profile, processing requirements, costs, and environmental impact. Current literature regarding AP suitability in LMIC contexts is limited. This perspective examined environmental and nutritional metrics that can assess the sustainability of AP in LMICs. Current research areas needed to accurately assess environmental impacts while considering nutritional density were identified. An overview of the usability of relevant AP in both high- and low-resource settings was also explored. Metrics addressing diverse contextual synergies in LMICs, unifying nutritional, environmental, and socioeconomic considerations, were found necessary to guide the integration of AP into LMIC diets.

Scaling up food pricing policies in the Pacific: a guide to action

There are calls for governments around the world to adopt pricing policies, including taxes, subsidies and price controls that ensure all people have access to, and can afford, healthy diets. Despite the strong potential of pricing policies to promote healthy diets and to support a post-COVID-19 recovery, there are gaps in evidence with regard to 'how' to design and apply effective food taxes in practice, and countries report challenges in navigating the different policy options.In this practice piece, we examine the global evidence for food taxes with a view to identifying practical lessons for policy design, adoption and implementation, using the Pacific Islands Region as a case study. We present a systematic resource that draws on locally generated evidence, and a Pacific conceptualisation of healthy diets, to address considerations in setting the tax base, rate and mechanisms, and to ensure tax targets are clearly identifiable within national tax and administrative systems. Health and Finance collaboration at the country level could ensure tax design addresses concerns for the impacts of food taxes on employment, economics and equity, as well as position food taxes as an opportunity to fund revenue shortfalls faced by governments following the COVID-19 pandemic. We demonstrate a need to review other policies for consistency with national health objectives to ensure that countries avoid inadvertently undermining health taxes, for example, by ensuring that foods with known non-communicable disease risk are not being price protected or promoted.

Towards credible, evidence-based environmental rating ecolabels for consumer products: A proposed framework

Environmental rating ecolabels are a new generation of ecolabels. They are intended to enable consumers to compare the environmental impacts of multiple products and make more sustainable consumption choices. Falling outside of the three types defined in the ISO 14020 environmental label and declarations series, the recent proliferation of these business-to-consumer communication instruments has resulted in the creation of a plethora of methodologies to derive product performance ratings. Interest from consumers wanting more information on the products they purchase, as well as the promise of policy instruments aiming to increase transparency and combat greenwashing, are fuelling further multiplication of schemes. A move towards more credible, evidence-based environmental rating ecolabels is therefore urgently needed to promote assessment based on scientific understanding, gain consumer trust, and realise policy objectives. We propose a framework based on four core principles - i) relevance, ii) scientific robustness, iii) trust and transparency, and iv) feasibility (scalability, affordability) - with 18 guidelines that can be followed by rating scheme developers. We characterise the rise of environmental rating ecolabels in geographical Europe and build an inventory of 33 existing schemes, at various stages of development and implementation, to which we apply the framework. This reveals the potential for significant improvement in current schemes, indicating important areas for development. The framework provides a valuable guide for the development of new schemes or an evaluation grid for existing initiatives.

Dietitians Australia position statement on healthy and sustainable diets

It is the position of Dietitians Australia that to promote human and planetary health, a food system transformation is needed that enables the population to adopt healthy and sustainable diet-related practices. A healthy and sustainable diet must (i) be nutritionally adequate, healthy and safe, (ii) have low environmental impact and be protective of natural resources and biodiversity, (iii) be culturally acceptable and (iv) be accessible, economically fair and affordable. Dietitians Australia acknowledges that it is critical to prioritise Indigenous knowledges in consultation, policy-making and implementation processes to achieve these recommendations. In facilitating the uptake of healthy and sustainable diets, dietitians are contributing to the transformation of our current food system that is urgently required to nourish present and future generations within planetary boundaries. In developing this position statement, opportunities for future research have been identified including those to advance the professions' capacity to improve environmental sustainability outcomes across all areas of practice. To achieve a population-level shift towards this diet, Dietitians Australia recommends: (i) the development of a National Food and Nutrition Strategy which honours Indigenous knowledges on food systems, (ii) the integration of sustainability principles in Australia's dietary guidelines, (iii) the reorientation of our food environment to prioritise access to healthy and sustainable foods, and (iv) investment in capacity building activities to equip the current and future nutrition and dietetics workforce.