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Stubbendorff A, Stern D, Ericson U, Sonestedt E, Hallström E, Borné Y, Lajous M, Forouhi NG, Olsen A, Dahm CC, Ibsen DB. A systematic evaluation of seven different scores representing the EAT-Lancet reference diet and mortality, stroke, and greenhouse gas emissions in three cohorts. Lancet Planet Health 2024; 8:e391-e401. [PMID: 38849181 DOI: 10.1016/s2542-5196(24)00094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 02/23/2024] [Accepted: 04/18/2024] [Indexed: 06/09/2024]
Abstract
Different approaches have been used for translation of the EAT-Lancet reference diet into dietary scores that can be used to assess health and environmental impact. Our aim was to compare the different EAT-Lancet diet scores, and to estimate their associations with all-cause mortality, stroke incidence, and greenhouse gas emissions. We did a systematic review (PROSPERO, CRD42021286597) to identify different scores representing adherence to the EAT-Lancet reference diet. We then qualitatively compared the diet adherence scores, including their ability to group individuals according the EAT-Lancet reference diet recommendations, and quantitatively assessed the associations of the diet scores with health and environmental outcome data in three diverse cohorts: the Danish Diet, Cancer and Health Cohort (DCH; n=52 452), the Swedish Malmö Diet and Cancer Cohort (MDC; n=20 973), and the Mexican Teachers' Cohort (MTC; n=30 151). The DCH and MTC used food frequency questionnaires and the MDC used a modified diet history method to assess dietary intake, which we used to compute EAT-Lancet diet scores and evaluate the associations of scores with hazard of all-cause mortality and stroke. In the MDC, dietary greenhouse gas emission values were summarised for every participant, which we used to predict greenhouse gas emissions associated with varying diet adherence scores on each scoring system. In our review, seven diet scores were identified (Knuppel et al, 2019; Trijsburg et al, 2020; Cacau et al, 2021; Hanley-Cook et al, 2021; Kesse-Guyot et al, 2021; Stubbendorff et al, 2022; and Colizzi et al, 2023). Two of the seven scores (Stubbendorff and Colizzi) were among the most consistent in grouping participants according to the EAT-Lancet reference diet recommendations across cohorts, and higher scores (greater diet adherence) were associated with decreased risk of mortality (in the DCH and MDC), decreased risk of incident stroke (in the DCH and MDC for the Stubbendorff score; and in the DCH for the Colizzi score), and decreased predicted greenhouse gas emissions in the MDC. We conclude that the seven different scores representing the EAT-Lancet reference diet had differences in construction, interpretation, and relation to disease and climate-related outcomes. Two scores generally performed well in our evaluation. Future studies should carefully consider which diet score to use and preferably use multiple scores to assess the robustness of estimations, given that public health and environmental policy rely on these estimates.
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Affiliation(s)
- Anna Stubbendorff
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Dalia Stern
- CONAHCyT-Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Cuernavaca, Mexico
| | - Ulrika Ericson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Emily Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Elinor Hallström
- Department of Agriculture and Food, Research Institutes of Sweden, Lund, Sweden
| | - Yan Borné
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Martin Lajous
- CONAHCyT-Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Cuernavaca, Mexico
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Anja Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark; Danish Cancer Society, Copenhagen, Denmark
| | | | - Daniel B Ibsen
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus Denmark; Department of Nutrition, Sports and Exercise, University of Copenhagen, Frederiksberg, Denmark
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Bell BM, Battaglia K, Wasim N, Marquez AS, Tichenor Blackstone N. The Society of Behavioral Medicine urges passage of the PLANT (Peas, Legumes, And Nuts Today) Act. Transl Behav Med 2024; 14:338-340. [PMID: 38727187 DOI: 10.1093/tbm/ibae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Current US diets negatively impact human health and the environment, while shifting toward increased intake of plant-based foods could mitigate these issues. Current food policies exacerbate these problems, necessitating a reevaluation and the implementation of new policies. The Society of Behavioral Medicine urges legislators to support the PLANT Act (H.R.5023), which would enhance production, research, and development of plant-based foods and address both health and environmental concerns.
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Affiliation(s)
- Brooke M Bell
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kyra Battaglia
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Natasha Wasim
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alejandra S Marquez
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Nicole Tichenor Blackstone
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Alves R, Perelman J, Chang K, Millett C. Environmental impact of dietary patterns in 10 European countries; a cross-sectional analysis of nationally representative dietary surveys. Eur J Public Health 2024:ckae088. [PMID: 38776529 DOI: 10.1093/eurpub/ckae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Changing dietary patterns is essential to reducing the substantial environment impact of agriculture and food production systems. We performed a cross-country comparison of dietary patterns and their associated environmental impact in Europe, including by sociodemographic factors. METHODS We analyzed pooled cross-sectional dietary records collected during 2010-18 from 10 European countries using the European Food Safety Authority (EFSA) Comprehensive European Food Database (16 508 adults; aged 18-79 years). Each food consumed was mapped to the corresponding environmental impact data using the SHARP Indicators Database, which provides greenhouse gas emission (GHGE) and land use (LU) values of approximately 900 foods. Total diet-associated environmental impact was calculated for each person and averaged across multiple days. Multivariable linear regression models were used to compare diet-associated GHGE and LU between population subgroups (gender, age, education and diet type) with country-level fixed effects. RESULTS The mean dietary GHGE and LU per capita ranged from 4.0 kgCO2/day and 5.0 m2*year/day in Spain to 6.5 kgCO2eq/day and 8.2 m2*year/day in France. Diet-related GHGE and LU (per kg/food) were lower among females (2.6 kgCO2eq/day, B = -0.08, P < 0.01; 3.2 m2*year/day, B = -0.11, P < 0.01), older population aged 66-79 (2.6 kgCO2eq/day, B = -0.03, P < 0.01; 3.4 m2*year/day, B = -0.4, P < 0.01), people following vegetarian diets (1.7 kgCO2eq/day, B = -0.07, P < 0.01; 2.0 m2*year/day, B = -0.07, P < 0.01), and higher among individuals with secondary education (2.7 kgCO2eq/day, B = 0.05, P < 0.01; 3.6 m2*year/day, B = -0.05, P < 0.01). CONCLUSIONS Environmental footprints vary substantially across countries, dietary patterns and between different sociodemographic groups in Europe. These findings are crucial for the development of country-specific food policies aimed at promoting environmentally sustainable diets.
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Affiliation(s)
- Ricardo Alves
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Kiara Chang
- School of Public Health, Imperial College London, Public Health Policy Evaluation Unit, London, UK
| | - Christopher Millett
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- School of Public Health, Imperial College London, Public Health Policy Evaluation Unit, London, UK
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Vuilleumier S. [Health issues related to the environment and the role of caregivers]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2024; 69:24-27. [PMID: 38762228 DOI: 10.1016/j.soin.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
The healthcare system and the practice of health care have unprecedented impacts on our environment. High carbon footprint, pollution and its consequences on health, the picture is not glorious. Even if they rarely identify themselves as such, healthcare professionals are key actors in the drive towards more sustainable practices. Their numbers, skills and activities give them privileged access to the population, communities and individuals of all ages and backgrounds. Thanks to their increasingly specialized training, they are in a position to accompany people on their health journey, prevent illness and promote healthy behaviours. These aspects are central to sustainability in healthcare.
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Affiliation(s)
- Séverine Vuilleumier
- Institut et haute école de la santé La Source, HES-SO, Haute école spécialisée de Suisse occidentale, avenue Alexandre-Vinet 30, 1004 Lausanne, Suisse.
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Eichholtzer AC, Driscoll DA, Patrick R, Galletta L, Lawson J. The co-benefits of biodiversity citizen science for well-being and nature relatedness. Appl Psychol Health Well Being 2024; 16:515-536. [PMID: 37876142 DOI: 10.1111/aphw.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023]
Abstract
Human well-being is dependent on the health of our planet. Biodiversity-related citizen science supports conservation research, and there is increasing interest in its potential as a health co-benefits intervention. This randomized controlled study investigates the health co-benefits of biodiversity citizen science participation. Seventy participants were randomly assigned to a citizen science project or control group for an 8-month period. Both groups completed pre- and post-intervention surveys, evaluating nature relatedness, self-efficacy related to biodiversity loss, subjective well-being, and climate change anxiety. A subset (N = 13) of participants engaged in the citizen science project also took part in focus group discussions. The intervention group reported a significant increase in nature relatedness and self-efficacy to help address issues of biodiversity loss. Although no significant changes were observed for other well-being or anxiety scales, most participants reported positive outcomes related to mental or physical well-being in focus groups. There were stronger positive effects for participants without previous environmental volunteering experience. These results suggest that citizen science participation has the potential to contribute to Planetary Health goals, with sustained co-benefits for well-being and nature relatedness. Future interventions evaluating co-benefits should consider previous environmental volunteering experience and focus on participants with little experience to maximize health outcomes.
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Affiliation(s)
- Anne C Eichholtzer
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia
| | - Don A Driscoll
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia
| | - Rebecca Patrick
- School of Population and Global Health, Melbourne University, Melbourne, Victoria, Australia
| | - Lorenzo Galletta
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia
| | - Justin Lawson
- School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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Rochefort G, Robitaille J, Lemieux S, Provencher V, Lamarche B. Are the 2019 Canada's Food Guide Recommendations on Healthy Food Choices Consistent with the EAT-Lancet Reference Diet from Sustainable Food Systems? J Nutr 2024; 154:1368-1375. [PMID: 38367810 PMCID: PMC11007739 DOI: 10.1016/j.tjnut.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND The diet proposed by the EAT-Lancet Commission, which supports both health and environmental sustainability, provides an opportunity to assess the sustainability of food-based dietary guidelines. OBJECTIVES The primary objective was to assess the alignment of the 2019 Canada's Food Guide (CFG) with the EAT-Lancet diet. To do so, an index assessing adherence to the EAT-Lancet diet was developed and evaluated. METHODS Data from 1147 adults were used from the cross-sectional PRÉDicteurs Individuals, Sociaux et Environnementaux (PREDISE) study conducted between 2015 and 2017 in the province of Québec. The EAT-Lancet Dietary Index (EAT-I) was developed to evaluate adherence to the EAT-Lancet diet. Adherence to the 2019 CFG was assessed using the Healthy Eating Food Index (HEFI)-2019. Associations between the HEFI-2019 score and component scores and the EAT-I score were examined using linear regression models. RESULTS The mean EAT-I score (/80) in this population was 33.4 points [95% confidence interval (CI): 32.2, 34.6]. EAT-I scores were consistent with expected differences in diet quality between females and males (+6.9 points, 95% CI: 4.8, 9.0) and between adults aged 50-65 y and 18-34 y (+4.3 points, 95% CI: 1.6, 7.0). The mean HEFI-2019 (/80) score was 44.9 points (95% CI: 44.1, 45.7). The HEFI-2019 was strongly associated with the EAT-I (ß = 0.76, 95% CI: 0.72, 0.80). Among the 10 components of the HEFI-2019, components such as the whole-grain foods (ß =4.01, 95% CI: 3.49, 4.52), grain foods ratio (ß =3.65, 95% CI: 3.24, 4.07), plant-based protein foods (ß =2.41, 95% CI: 2.03, 2.78), and fatty acids ratio (ß =3.12, 95% CI: 2.72, 3.51) showed the strongest associations with the EAT-I. CONCLUSIONS These results suggest that recommendations in the 2019 CFG are largely coherent with the EAT-Lancet diet underscoring the complementarity and compatibility of the 2019 CFG for sustainability and health promotion purposes.
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Affiliation(s)
- Gabrielle Rochefort
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC, Canada; École de Nutrition, Faculté des sciences de l'agriculture et de l'alimentation, Université Laval, Québec, QC, Canada
| | - Julie Robitaille
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC, Canada; École de Nutrition, Faculté des sciences de l'agriculture et de l'alimentation, Université Laval, Québec, QC, Canada
| | - Simone Lemieux
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC, Canada; École de Nutrition, Faculté des sciences de l'agriculture et de l'alimentation, Université Laval, Québec, QC, Canada
| | - Véronique Provencher
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC, Canada; École de Nutrition, Faculté des sciences de l'agriculture et de l'alimentation, Université Laval, Québec, QC, Canada
| | - Benoît Lamarche
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC, Canada; École de Nutrition, Faculté des sciences de l'agriculture et de l'alimentation, Université Laval, Québec, QC, Canada.
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7
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Ronto R, Alves Lopes CV, Bogueva D, Davis B, Bhatti AJ, Navarrete P, Chau JY. Exploring Australian News Media Portrayals of Sustainable and Plant-Based Diets. Nutrients 2024; 16:996. [PMID: 38613028 PMCID: PMC11013140 DOI: 10.3390/nu16070996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Dietary behaviour transformation is imperative for the attainment of more sustainable food systems, including an increased intake of plant-based foods and lower consumption of red meat and highly processed foods. The influence of news media coverage on public opinion regarding dietary behaviours is significant. Therefore, this study aimed to explore how sustainable/plant-based diets have been portrayed in Australian news media. (2) Methods: The Factiva global news database was used to search news articles published in Australia between 2018 and 2020. Relevant news articles were selected if they included keywords relating to sustainable diets, plant-based diets, and meat alternatives. We used a coding protocol to extract key information, such as date of publication, article topic, and any health, environmental and economic impacts. Then, we performed a framing and thematic analysis of the data. (3) Results: From 357 included articles, more than half of the articles encouraged increasing the intake of plant-based foods (53.5%) and reducing animal-derived food intake (55.2%). Several reasons for such shift from animal protein centric Australian diets were identified throughout the articles such as health benefits (15.4%), environmental impacts (11.2%), animal welfare (4.8%), seasonality and local food intake (5.3%), avoiding overconsumption (4.5%) and food wastage (4.5%). (4) Conclusions: The predominant frame in Australian news coverage about sustainable diets has been about consumption, more plant- and less animal-based products, with little nuance about the complex interplay of diet quality and environment in influencing food choices. Australian news media should broaden its coverage of sustainable diets to include health, environmental, and economic factors to improve public understanding and facilitate informed and sustainable food choices. Further research is needed to enhance comprehension of how the audience perceives media coverage on this topic, which will provide a more thorough understanding.
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Affiliation(s)
- Rimante Ronto
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Carla Vanessa Alves Lopes
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Diana Bogueva
- Curtin University Sustainability Policy Institute (CUSP), Curtin University, Perth, WA 6102, Australia
| | - Barbara Davis
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Alexandra J. Bhatti
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Priscilla Navarrete
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Josephine Y. Chau
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
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Cacau LT, Hanley-Cook GT, Vandevijvere S, Leclercq C, De Henauw S, Santaliestra-Pasias A, Manios Y, Mourouti N, Esperanza Díaz L, Gonzalez-Gross M, Widhalm K, Molnar D, Stehle P, Kafatos A, Gottrand F, Kersting M, Castillo M, Lachat C, Marchioni DM, Huybrechts I, Moreno LA. Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: the HELENA study. Eur J Clin Nutr 2024; 78:202-208. [PMID: 38093098 DOI: 10.1038/s41430-023-01379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND The EAT-Lancet Commission proposed a global reference diet to promote healthy diets within planetary boundaries. Studies evaluating the associations between the reference diet with health outcomes among adolescents are scarce. Thus, our aim was to assess the association between adherence to the EAT-Lancet diet and cardiovascular health among European adolescents. METHODS Data from the HELENA study were used. Usual dietary intake was assessed using two 24-h dietary recalls and adherence to the EAT-Lancet diet was assessed using the Planetary Health Diet Index (PHDI), a 16-component index that ranges from 0 to 150 points. Cardiovascular health was assessed through the seven-component Ideal Cardiovascular Health (ICH) score: never smoked, eutrophic body mass index, moderate-to-vigorous physical activity, healthy dietary pattern, low blood pressure, low fasting plasma glucose, and low total cholesterol. Total ICH score was categorized into ideal (5-7) and non-ideal (0-4). RESULTS A 10-point increment in the PHDI was associated with a lower probability of a non-ideal ICH status (OR 0.84, [95% CI: 0.75, 0.94]) among European adolescents, after adjusting for age, sex, socio-economic status, and total energy intake. Furthermore, a 10-point increment in the PHDI was associated with lower probability of high blood pressure (OR: 0.87 [0.79, 0.96]) and a lower probability of high blood cholesterol (OR: 0.88 [0.78, 0.99]). CONCLUSION Our study suggests that a higher PHDI may be associated with a better cardiovascular health status among European adolescents.
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Affiliation(s)
- Leandro Teixeira Cacau
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Giles T Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Catherine Leclercq
- Council for Agricultural Research and Economics - Research Center for Food and Nutrition (CREA - Food and Nutrition), Rome, Italy
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Alba Santaliestra-Pasias
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto Agroalimentario de Aragon (IA2), 50013, Zaragoza, Spain
- Instituto de Investigacion Sanitaria Aragon (IIS Aragon), 50009, Zaragoza, Spain
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671, Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, 71410, Heraklion, Greece
| | - Niki Mourouti
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671, Athens, Greece
- Department of Nutrition and Dietetics, Hellenic Mediterranean University, 72300, Sitia, Greece
| | - Ligia Esperanza Díaz
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition (ICTAN)-CSIC, 28040, Madrid, Spain
| | - Marcela Gonzalez-Gross
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Kurt Widhalm
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Dénes Molnar
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Peter Stehle
- Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
| | - Anthony Kafatos
- Faculty of Medicine, University of Crete, Crete, 71500, Heraklion, Greece
| | - Frederic Gottrand
- Institute for Translational Research in Inflammation (INFINITE), University Lille, Lille, France
| | - Mathilde Kersting
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Manuel Castillo
- Department of Medical Physiology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Inge Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Instituto Agroalimentario de Aragon (IA2), 50013, Zaragoza, Spain
- Instituto de Investigacion Sanitaria Aragon (IIS Aragon), 50009, Zaragoza, Spain
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9
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Bunge AC, Mazac R, Clark M, Wood A, Gordon L. Sustainability benefits of transitioning from current diets to plant-based alternatives or whole-food diets in Sweden. Nat Commun 2024; 15:951. [PMID: 38296977 PMCID: PMC10831109 DOI: 10.1038/s41467-024-45328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024] Open
Abstract
Plant-based alternatives (PBAs) are increasingly becoming part of diets. Here, we investigate the environmental, nutritional, and economic implications of replacing animal-source foods (ASFs) with PBAs or whole foods (WFs) in the Swedish diet. Utilising two functional units (mass and energy), we model vegan, vegetarian, and flexitarian scenarios, each based on PBAs or WFs. Our results demonstrate that PBA-rich diets substantially reduce greenhouse gas emissions (30-52%), land use (20-45%), and freshwater use (14-27%), with the vegan diet showing the highest reduction potential. We observe comparable environmental benefits when ASFs are replaced with WFs, underscoring the need to reduce ASF consumption. PBA scenarios meet most Nordic Nutrition Recommendations, except for vitamin B12, vitamin D and selenium, while enhancing iron, magnesium, folate, and fibre supply and decreasing saturated fat. Daily food expenditure slightly increases in the PBA scenarios (3-5%) and decreases in the WF scenarios (4-17%), with PBA diets being 10-20% more expensive than WF diets. Here we show, that replacing ASFs with PBAs can reduce the environmental impact of current Swedish diets while meeting most nutritional recommendations, but slightly increases food expenditure. We recommend prioritising ASF reduction and diversifying WFs and healthier PBAs to accommodate diverse consumer preferences during dietary transitions.
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Affiliation(s)
| | - Rachel Mazac
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Helsinki Institute of Sustainability Sciences (HELSUS), University of Helsinki, Helsinki, Finland
- Department of Agricultural Sciences, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Michael Clark
- Smith School of Enterprise and the Environment, Oxford, UK
- Department of Biology, University of Oxford, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
| | - Amanda Wood
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Line Gordon
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
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Skurk T, Grünerbel A, Hummel S, Kabisch S, Keuthage W, Müssig K, Nussbaumer H, Rubin D, Simon MC, Tombek A, Weber KS. Nutritional Recommendations for the Prevention of Type 2 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2024; 132:68-82. [PMID: 38232741 DOI: 10.1055/a-2166-6943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Thomas Skurk
- ZIEL - Institute for Food & Health, Core Facility Human Studies, Technical University Munich, Freising, Germany
| | | | - Sandra Hummel
- Helmholtz Diabetes Centre Institute of Diabetes Research Munich, Research Centre for Health and Environment (GmbH), Munich-Neuherberg, Germany
| | - Stefan Kabisch
- German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
| | - Winfried Keuthage
- Specialist Practice for Diabetes and Nutritional Medicine, Münster, Germany
| | - Karsten Müssig
- Department of Internal Medicine, Gastroenterology and Diabetology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany
| | | | - Diana Rubin
- Vivantes Hospital Spandau, Berlin, Germany
- Vivantes Humboldt Hospital, Berlin, Germany
| | - Marie-Christine Simon
- Institute of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Astrid Tombek
- Diabetes Centre Bad Mergentheim, Bad Mergentheim, Germany
| | - Katharina S Weber
- Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
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11
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Aljahdali AA, Campos H, Granados K, Jones AD, Baylin A. Diet-Attributable Greenhouse Gas Emissions and Acute Myocardial Infarction in Costa Rica Heart Study. Nutrients 2023; 16:138. [PMID: 38201967 PMCID: PMC10780829 DOI: 10.3390/nu16010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/24/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Adopting sustainable dietary patterns is essential for planetary and human health. As data to address this issue are lacking in Latino populations, this study examined the association between diet-attributable greenhouse gas emissions (GHGEs) and myocardial infarction (MI) in a Costa Rica Heart Study. This analysis included 1817 cases of a first non-fatal acute MI during hospitalization and their matched population-based controls, by age, sex, and area of residence. A validated food frequency questionnaire was used to quantify habitual dietary intake and diet-attributable GHGEs (kg CO2 equivalent (eq.)/year). Due to the matching design, conditional logistic regression was used. Red meat consumption contributed approximately 50% to the total diet-attributable GHGEs among both cases and controls. Higher diet-attributable GHGEs were associated with increased odds of acute MI. The odds of MI were 63% higher (OR = 1.63; 95% CI 1.20-2.21) among participants in the highest quintile (median diet-attributable GHGEs = 6247 kg CO2 eq./year) compared to the lowest quintile (median diet-attributable GHGEs = 2065 kg CO2 eq./year). An increasing linear trend in the odds of acute MI and diet-attributable GHGEs was detected (p-trend 0.0012). These findings highlight the importance of reducing red meat consumption to sustainably mitigate the incidence of MI and improve planetary health.
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Affiliation(s)
- Abeer A. Aljahdali
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Hannia Campos
- Center for Research and Innovation in Translational Nutrition, Universidad Hispanoamericana, San Jose 10101, Costa Rica; (H.C.); (K.G.)
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Keylin Granados
- Center for Research and Innovation in Translational Nutrition, Universidad Hispanoamericana, San Jose 10101, Costa Rica; (H.C.); (K.G.)
| | - Andrew D. Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA;
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ana Baylin
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA;
- Department of Global Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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12
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Dötsch-Klerk M, Carvalho S, Lawrence CF, Willems JI. Improving the nutrient quality of foods and beverages using product specific standards for positive nutrients and ingredients will help to increase mean population intakes toward dietary guidelines. Front Nutr 2023; 10:1292231. [PMID: 38125725 PMCID: PMC10730655 DOI: 10.3389/fnut.2023.1292231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Background A shift toward more sustainable diets, rich in plant-based foods and with fewer animal-derived foods, is needed and will lead to improved health and environmental benefits. Food industry needs to play a part and broaden the scope of product reformulation beyond the reduction of nutrients to limit to increasing ingredients and nutrients in line with dietary recommendations for a healthy sustainable diet. Methods The Positive Nutrition Standards (PNS) were defined to increase the consumption of recommended ingredients and nutrients. The PNS were set by translating WHO and Codex guidance into product group standards, considering the role of the product group in the diet. The potential impact of the PNS for vegetables, wholegrain and fibre was modeled using data from the US NHANES 2017-2018 survey, assuming that, foods consumed would be reformulated to meet the standards where relevant. Results The modeling showed that application of the PNS could increase mean population intakes by 30% for fibre, by more than 50% for vegetables and even double the intake of wholegrain. However, reformulation alone would not be sufficient to reach recommended intake levels. Conclusion The PNS described in this paper can help to increase intakes of relevant positive nutrients and ingredients. However, a multistakeholder approach is needed to encourage consumers to make additionally required dietary shifts to meet the recommendations for positive nutrients and ingredients.
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Affiliation(s)
| | - Sara Carvalho
- Unilever Foods Innovation Centre, Wageningen, Netherlands
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13
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Wright EC, van Oort B, Bjøntegaard MM, Carlsen MH, Andersen LF. Environmental and nutritional assessment of young children's diets in Norway: comparing the current diet with national dietary guidelines and the EAT-Lancet reference diet. Eur J Nutr 2023; 62:3383-3396. [PMID: 37653070 PMCID: PMC10611869 DOI: 10.1007/s00394-023-03243-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Introducing healthy and sustainable diets early in life can promote lifelong healthy dietary patterns with a low environmental impact. Therefore, we aimed to estimate the environmental and nutritional consequences of a dietary change for 2-year-old children in Norway towards healthier dietary patterns. METHODS Environmental impacts of the current habitual diet among 2-year-olds (n = 1413) were estimated for six impact categories and compared with scenario diets based on the Norwegian food-based dietary guidelines (FBDG) and the EAT-Lancet Commission reference diet. Last, we evaluated the nutritional adequacy of the diets against the Norwegian nutrition recommendations for children aged 2-5 years. The current diet was assessed by an FFQ. RESULTS Environmental impacts of the current habitual diet were up to two times higher than those of the scenario diets. Compared with the current diet, impacts from the FBDG scenario diet were reduced by 35% for water use and 18% for terrestrial acidification, whereas impacts from the EAT-Lancet scenario diet were reduced by 51% for water use, 57% for terrestrial acidification, 36% for global warming potential and 27% for freshwater eutrophication. Milk and dairy products were the main contributors to environmental impacts in both the current diet and the FBDG scenario diet. The scenario diets were nutritionally adequate and improved the dietary quality among Norwegian 2-year-olds. CONCLUSION Compared to current diets among young children, more plant-based dietary patterns in line with national FBDG or the EAT-Lancet Commission reference diet can improve the nutritional adequacy of diets and simultaneously reduce environmental impacts.
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Affiliation(s)
| | - Bob van Oort
- CICERO Center for International Climate Research, Oslo, Norway
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14
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Viroli G, Kalmpourtzidou A, Cena H. Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability. Nutrients 2023; 15:4723. [PMID: 38004117 PMCID: PMC10675717 DOI: 10.3390/nu15224723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.
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Affiliation(s)
- Giulia Viroli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
| | - Aliki Kalmpourtzidou
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
- Clinical Nutrition Unit, General Medicine, ICS Maugeri IRCCS, 27100 Pavia, Italy
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15
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Leydon CL, Leonard UM, McCarthy SN, Harrington JM. Aligning Environmental Sustainability, Health Outcomes, and Affordability in Diet Quality: A Systematic Review. Adv Nutr 2023; 14:1270-1296. [PMID: 37532100 PMCID: PMC10721486 DOI: 10.1016/j.advnut.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
Improving diet quality while simultaneously maintaining planetary health is of critical interest globally. Despite the shared motivation, advancement remains slow, and the research community continues to operate in silos, focusing on certain pairings (diet-climate), or with a discipline-specific lens of a sustainable diet, rather than examining their totality. This review aimed to summarize the literature on adherence to a priori defined dietary patterns in consideration of diet quality, metabolic risk factors for noncommunicable diseases (NCDs), environmental impacts, and affordability. A methodology using PRISMA guidelines was followed, and searches were performed in 7 databases as of October 2022. The Appraisal tool for Cross-Sectional Studies (AXIS) and the National Institutes of Health (NIH) quality assessment tool for observational cohort studies were employed for quality appraisal. The evidence was narratively synthesized according to the characteristics of the diet quality metrics. The review includes 24 studies published between 2017-2023. Thirteen distinct diet quality scores were identified, with those measuring adherence to national dietary guidelines the most reported. Thirteen distinct environmental impact indicators were identified, with greenhouse gas emissions (n=23) reported most. All studies reported on body mass index, and 7 studies assessed the cost of adherence. Our results are consistent with previous findings that healthier diets can reduce environmental impacts; however, incongruities between population and planetary health can occur. Hence, the "sustainability" of dietary patterns is dependent on the choice of indicators selected. Further, healthy, lower impact diets can increase financial cost, but may also provide a protective role against the risk of obesity. Given the Global Syndemic, strategies to reduce obesity prevalence should emphasize the win-win opportunities for population and planetary health through dietary change. Research should identify diets that address multiple environmental concerns to curtail burdens potentially transferring, and harmonize this with sociocultural and equity dimensions. This review was registered at PROSPERO as CRD42021238055.
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Affiliation(s)
- Clarissa L Leydon
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland; Department of Agrifood Business and Spatial Analysis, Teagasc Food Research Centre, Ashtown, Dublin, Ireland.
| | - Ursula M Leonard
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Sinéad N McCarthy
- Department of Agrifood Business and Spatial Analysis, Teagasc Food Research Centre, Ashtown, Dublin, Ireland
| | - Janas M Harrington
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
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Ren X, Yu C, Peng L, Gu H, Xiao Y, Tang Y, He H, Xiang L, Wang Y, Jiang Y. Compliance with the EAT-Lancet diet and risk of colorectal cancer: a prospective cohort study in 98,415 American adults. Front Nutr 2023; 10:1264178. [PMID: 37927505 PMCID: PMC10621045 DOI: 10.3389/fnut.2023.1264178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Background The EAT-Lancet diet (ELD) is a recommended dietary pattern for achieving simultaneous improvements in both individual health and environmental sustainability. While research on the association between ELD and colorectal cancer (CRC) remains scarce, the potential impact of nutrition on CRC prevention and progression is a topic of growing interest. This study aims to investigate the relationship between adherence to the ELD and the risk of CRC, shedding light on the role of nutrition in CRC prevention. Methods A total of 98,415 participants were included. A Diet History Questionnaire (DHQ) was used to collect dietary information, and an ELD score was used to assess adherence to ELD. Higher scores indicated greater adherence. Cox hazard regression analyses were conducted to examine whether there were associations between the ELD score and CRC risk. The restricted cubic spline (RCS) model was used to further explore the dose-response association between the ELD score and CRC incidence. Subgroup analyses were conducted to identify potential modifiers that interacted with ELD on CRC incidence, and sensitivity analyses were performed to evaluate the robustness of the established association. Results During a mean follow-up of 8.82 years, a total of 1,054 CRC cases were documented. We found a statistically significant correlation between the ELD score and CRC risk (Q4 vs. Q1: HR 0.81, 95% CI 0.67-0.98; P for trend = 0.034) after adjusting for potential confounders. No statistically significant associations were discovered between ELD adherence and CRC by anatomical site. Subgroup analyses found no interactional factor, sensitivity analyses, and the RCS model showed a robustness and linearity association (P-linearity >0.05). Conclusion We concluded that adherence to ELD contributes to the prevention of CRC.
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Affiliation(s)
- Xiaorui Ren
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuanchuan Yu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Linglong Peng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Gu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Xiao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunhao Tang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongmei He
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Xiang
- Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yaxu Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yahui Jiang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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17
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Ye YX, Geng TT, Zhou YF, He P, Zhang JJ, Liu G, Willett W, Pan A, Koh WP. Adherence to a Planetary Health Diet, Environmental Impacts, and Mortality in Chinese Adults. JAMA Netw Open 2023; 6:e2339468. [PMID: 37874563 PMCID: PMC10599124 DOI: 10.1001/jamanetworkopen.2023.39468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
Importance Although the EAT-Lancet Commission has recently proposed a planetary health diet (PHD) to promote human and environmental health, little is known about how PHD affects environment and mortality risk among an Asian population. Objective To investigate whether a PHD score is associated with environmental impacts and mortality outcomes in a Chinese cohort living in Singapore. Design, Setting, and Participants This cohort study used data from the Singapore Chinese Health Study. Eligible participants were without known cardiovascular disease and cancer at baseline; they were recruited between 1993 and 1998 and followed up using record linkage data until 2020. Data were analyzed from September 2022 to April 2023. Exposures PHD score was calculated based on the reference consumption of 14 dietary components in PHD and individual energy intake assessed using a validated food frequency questionnaire in this cohort. Main Outcomes and Measures Diet-related environmental impacts were estimated using a food frequency questionnaire. Mortality outcomes (all-cause, cardiovascular disease, cancer, and respiratory disease) were identified via linkage with a nationwide registry. Results A total of 57 078 participants were included in this study (mean [SD] age, 56.1 (7.9) years; 31 958 women [56.0%]). During a median (IQR) follow-up of 23.4 (18.7-26.2) years, 22 599 deaths occurred. Comparing the highest and lowest quintiles, higher PHD scores were associated with lower greenhouse gas emissions (β = -0.13 kg CO2 equivalent; 95% CI, -0.14 to -0.12 kg CO2 equivalent), but with higher total water footprint (β = 0.12 m3; 95% CI, 0.11-0.13 m3) and land use (β = 0.29 m2; 95% CI, 0.28-0.31 m2). In the adjusted multivariable model, compared with the lowest quintile, participants in the highest quintile of PHD score had lower risk of all-cause mortality (hazard ratio [HR], 0.85; 95% CI, 0.81-0.89), cardiovascular disease mortality (HR, 0.79; 95% CI, 0.73-0.85), cancer mortality (HR, 0.93; 95% CI, 0.86-1.00), and respiratory disease mortality (HR, 0.81; 95% CI, 0.74-0.89). Conclusions and Relevance In this study of Singapore Chinese adults, higher adherence to PHD was associated with reduced risk of chronic disease mortality. However, environmental impacts were uncertain, as higher adherence was associated with lower greenhouse gas emissions but higher total water footprint and land use.
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Affiliation(s)
- Yi-Xiang Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting-Ting Geng
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
| | - Yan-Feng Zhou
- Department of Social Medicine and Health Management, School of Public Health, Guangxi Medical University, Nanning, China
| | - Pan He
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, United Kingdom
| | - Ji-Juan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Walter Willett
- Harvard T.H. Chan School of Public Health, Harvard Medical School, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
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Cacau LT, Hanley-Cook GT, Huybrechts I, De Henauw S, Kersting M, Gonzalez-Gross M, Gottrand F, Ferrari M, Nova E, Castillo MJ, Molnár D, Widhalm K, Androutsos O, Manios Y, Stehle P, Lachat C, Marchioni DM, Moreno LA. Relative validity of the Planetary Health Diet Index by comparison with usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet among European adolescents: the HELENA study. Eur J Nutr 2023; 62:2527-2539. [PMID: 37171585 DOI: 10.1007/s00394-023-03171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The EAT-Lancet Commission proposed an evidence-based global reference diet to improve human health within planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) was developed based on the EAT-Lancet recommendations and validated among Brazilian adults. However, the relative validity of the PHDI in adolescents has yet to be assessed. Thus, we aimed to evaluate the relative validity of the PHDI in European adolescents. METHODS We used cross-sectional data from 1804 adolescents (12.5-17.5 years) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. The PHDI (0-150 points) was calculated based on dietary intake data from two non-consecutive 24-h dietary recalls. Associations between the PHDI and usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet were evaluated using multivariable-adjusted mixed-effects linear regression models. RESULTS Higher PHDI score was associated with greater intakes of nutrients predominantly from plant-source foods, such as vegetable protein, vitamin E, and folate and with lower intake of nutrients predominately from animal-source foods, such as total and saturated fat, cholesterol, and animal protein. Furthermore, a higher PHDI score was also positively associated with plasma β-carotene, vitamin C, vitamin D, folate, and ferritin concentrations, while negatively associated with trans-fatty acids concentration. Moreover, higher PHDI was related to a greater adherence to the Mediterranean dietary pattern. CONCLUSIONS The PHDI showed good relative validity among adolescents in the HELENA study. Hence, future research should assess adherence to the PHDI and long-term health outcomes.
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Affiliation(s)
- Leandro Teixeira Cacau
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de La Salud, Universidad de Zaragoza, Zaragoza, Spain.
- Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, São Paulo, SP, 01246-904, Brazil.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Giles T Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Inge Huybrechts
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mathilde Kersting
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Marcela Gonzalez-Gross
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Frederic Gottrand
- Institute for Translational Research in Inflammation (INFINITE), University Lille, Lille, France
| | - Marika Ferrari
- Council for Agricultural Research and Economics, Research Center for Food and Nutrition, Rome, Italy
| | - Esther Nova
- Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - Manuel J Castillo
- Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Dénes Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Kurt Widhalm
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Peter Stehle
- Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, São Paulo, SP, 01246-904, Brazil
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de La Salud, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Instituto Agroalimentario de Aragon (IA2), Zaragoza, Spain
- Instituto de Investigacion Sanitaria Aragon (IIS Aragon), Zaragoza, Spain
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Nordman M, Lassen AD, Stockmarr A, van ‘t Veer P, Biesbroek S, Trolle E. Exploring healthy and climate-friendly diets for Danish adults: an optimization study using quadratic programming. Front Nutr 2023; 10:1158257. [PMID: 37396137 PMCID: PMC10307962 DOI: 10.3389/fnut.2023.1158257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background A transition to healthy and sustainable diets has the potential to improve human and planetary health but diets need to meet requirements for nutritional adequacy, health, environmental targets, and be acceptable to consumers. Objective The objective of this study was to derive a nutritionally adequate and healthy diet that has the least deviation possible from the average observed diet of Danish adults while aiming for a greenhouse gas emission (GHGE) reduction of 31%, corresponding to the GHGE level of the Danish plant-rich diet, which lays the foundation for the current healthy and sustainable food-based dietary guidelines (FBDGs) in Denmark. Methods With an objective function minimizing the departure from the average observed diet of Danish adults, four diet optimizations were run using quadratic programming, with different combinations of diet constraints: (1) nutrients only (Nutri), (2) nutrients and health-based targets for food amounts (NutriHealth), (3) GHGE only (GHGE), and finally, (4) combined nutrient, health and GHGE constraints (NutriHealthGHGE). Results The GHGE of the four optimized diets were 3.93 kg CO2-eq (Nutri), 3.77 kg CO2-eq (NutriHealth) and 3.01 kg CO2-eq (GHGE and NutriHealthGHGE), compared to 4.37 kg CO2-eq in the observed diet. The proportion of energy from animal-based foods was 21%-25% in the optimized diets compared to 34% in the observed diet and 18% in the Danish plant-rich diet. Moreover, compared to the average Danish diet, the NutriHealthGHGE diet contained more grains and starches (44 E% vs. 28 E%), nuts (+230%), fatty fish (+89%), eggs (+47%); less cheese (-73%), animal-based fats (-76%), total meat (-42%); and very limited amounts of ruminant meat, soft drinks, and alcoholic beverages (all-90%), while the amounts of legumes and seeds were unchanged. On average, the mathematically optimized NutriHealthGHGE diet showed a smaller deviation from the average Danish diet compared to the Danish plant-rich diet (38% vs. 169%, respectively). Conclusion The final optimized diet presented in this study represents an alternative way of composing a nutritionally adequate and healthy diet that has the same estimated GHGE as a diet consistent with the climate-friendly FBDGs in Denmark. As this optimized diet may be more acceptable for some consumers, it might help to facilitate the transition toward more healthy and sustainable diets in the Danish population.
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Affiliation(s)
- Matilda Nordman
- National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anne Dahl Lassen
- National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Pieter van ‘t Veer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Sander Biesbroek
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Ellen Trolle
- National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
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Gatto A, Kuiper M, van Meijl H. Economic, social and environmental spillovers decrease the benefits of a global dietary shift. NATURE FOOD 2023:10.1038/s43016-023-00769-y. [PMID: 37277490 DOI: 10.1038/s43016-023-00769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
Dietary shifts are key for enhancing the sustainability of current food systems but need to account for potential economic, social and environmental indirect effects as well. By tracing physical quantities of biomass along supply chains in a global economic model, we investigate the benefits of adopting the EAT-Lancet diet and other social, economic and environmental spillovers in the wider economy. We find that decreased global food demand reduces global biomass production, food prices, trade, land use and food loss and waste but also reduces food affordability for low-income agricultural households. In sub-Saharan Africa, increased food demand and higher prices decrease food affordability also for non-agricultural households. Economic spillovers into non-food sectors limit agricultural land and greenhouse gas reductions as cheaper biomass is demanded more for non-food use. From an environmental perspective, economy-wide greenhouse gas emissions increase as lower global food demand at lower prices frees income subsequently spent on non-food items.
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Affiliation(s)
- Alessandro Gatto
- Department of Agricultural Economics and Rural Policy, Wageningen University and Wageningen Economic Research, Wageningen, The Netherlands.
| | - Marijke Kuiper
- Department of International Policy, Wageningen University and Wageningen Economic Research, Wageningen, The Netherlands
| | - Hans van Meijl
- Department of Agricultural Economics and Rural Policy, Wageningen University and Wageningen Economic Research, Wageningen, The Netherlands
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Baudry J, Allès B, Langevin B, Reuzé A, Brunin J, Touvier M, Hercberg S, Lairon D, Péneau S, Pointereau P, Kesse-Guyot E. Associations between measures of socio-economic position and sustainable dietary patterns in the NutriNet-Santé study. Public Health Nutr 2023; 26:965-975. [PMID: 36213945 PMCID: PMC10346073 DOI: 10.1017/s1368980022002208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/04/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We aimed to explore the relationship between socio-economic characteristics and sustainable dietary patterns. DESIGN Dietary data were derived from a web-based FFQ. Diet sustainability was evaluated using a modified Sustainable Diet Index, comprising nutritional, environmental and cultural components (higher scores expressing higher sustainability). The socio-economic position markers were education, household income and occupation status. Multi-adjusted linear and Poisson regression models were used to assess the cross-sectional association of the markers of socio-economic status with a sustainable diet and sustainability subcomponents, respectively. SETTING France. PARTICIPANTS 29 119 NutriNet-Santé participants. RESULTS Individuals with a more sustainable diet had slightly higher diet monetary cost, lower total energy intake and consumed less animal-based foods than their counterparts. Lower education level was associated with lower overall diet sustainability (βprimary v. postgraduate = -0·62, 95 % CI (-0·72, -0·51)) and nutrition, socio-cultural and environmental subscores. Manual workers and employees had a lower modified Sustainable Diet Index than intermediate professionals (βmanual workers v. intermediate professionals = -0·43, 95 % CI (-0·52, -0·33) and βemployees v. intermediate professionals = -0·56, 95 % CI (-0·64, -0·48)). Participants with the lowest v. highest incomes had a higher environmental subscore but a lower socio-cultural subscore, whereas the results were less marked for occupational status. CONCLUSIONS Overall, our results documented associations between socio-economic status and the level of diet sustainability, arguing for the implementation of appropriate food policies to promote sustainable diets at lower cost.
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Affiliation(s)
- Julia Baudry
- Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, Université Paris Cité (CRESS), UFR SMBH 74, Rue Marcel Cachin, Bobigny93017, France
| | - Benjamin Allès
- Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, Université Paris Cité (CRESS), UFR SMBH 74, Rue Marcel Cachin, Bobigny93017, France
| | | | - Anouk Reuzé
- Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, Université Paris Cité (CRESS), UFR SMBH 74, Rue Marcel Cachin, Bobigny93017, France
| | - Joséphine Brunin
- Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, Université Paris Cité (CRESS), UFR SMBH 74, Rue Marcel Cachin, Bobigny93017, France
- ADEME (Agence de l’Environnement et de la Maîtrise de l’Energie), Angers, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, Université Paris Cité (CRESS), UFR SMBH 74, Rue Marcel Cachin, Bobigny93017, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, Université Paris Cité (CRESS), UFR SMBH 74, Rue Marcel Cachin, Bobigny93017, France
- Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Denis Lairon
- Aix Marseille University, Inserm, INRAE, C2VN, Marseille, France
| | - Sandrine Péneau
- Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, Université Paris Cité (CRESS), UFR SMBH 74, Rue Marcel Cachin, Bobigny93017, France
| | | | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, Université Paris Cité (CRESS), UFR SMBH 74, Rue Marcel Cachin, Bobigny93017, France
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Ratter-Rieck JM, Roden M, Herder C. Diabetes and climate change: current evidence and implications for people with diabetes, clinicians and policy stakeholders. Diabetologia 2023; 66:1003-1015. [PMID: 36964771 PMCID: PMC10039694 DOI: 10.1007/s00125-023-05901-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 03/26/2023]
Abstract
Climate change will be a major challenge for the world's health systems in the coming decades. Elevated temperatures and increasing frequencies of heat waves, wildfires, heavy precipitation and other weather extremes can affect health in many ways, especially if chronic diseases are already present. Impaired responses to heat stress, including compromised vasodilation and sweating, diabetes-related comorbidities, insulin resistance and chronic low-grade inflammation make people with diabetes particularly vulnerable to environmental risk factors, such as extreme weather events and air pollution. Additionally, multiple pathogens show an increased rate of transmission under conditions of climate change and people with diabetes have an altered immune system, which increases the risk for a worse course of infectious diseases. In this review, we summarise recent studies on the impact of climate-change-associated risk for people with diabetes and discuss which individuals may be specifically prone to these risk conditions due to their clinical features. Knowledge of such high-risk groups will help to develop and implement tailored prevention and management strategies to mitigate the detrimental effect of climate change on the health of people with diabetes.
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Affiliation(s)
- Jacqueline M Ratter-Rieck
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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EAT-Lancet Healthy Reference Diet score and diabetes incidence in a cohort of Mexican women. Eur J Clin Nutr 2023; 77:348-355. [PMID: 36471166 DOI: 10.1038/s41430-022-01246-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/11/2022]
Abstract
To improve the health of our planet and develop sustainable food policies, it is important to understand the health impact of a diet pattern that considers planetary and population health. We used data from the Mexican Teachers' Cohort (MTC) to estimate the association between the EAT-Lancet healthy reference diet (EAT-HRD) and type 2 diabetes (T2D) incidence. We included 74,671 women aged ≥25 years, free of T2D at baseline. A validated food frequency questionnaire (FFQ) was used to assess dietary intake. We created an EAT-HRD score based on 15 food groups recommended by the EAT-Lancet Commission (range from 0 to 15). T2D cases were identified through self-report and cross-linkage with clinical and administrative databases. We used Cox proportional hazards models to estimate the association between categories of the EAT-HRD score with T2D incidence. During a median follow-up of 2.16 y (IQR 1.8-4.3 y), we identified 3241 T2D incident cases. The median EAT-HRD score was 6 (IQR 5-7). In multivariable analyses, when comparing extreme categories, higher adherence to the EAT-HRD score was associated with lower T2D incidence (HR 0.90; 95% CI 0.75, 1.10), yet, the estimation was imprecise. Compared to those who did not meet the EAT-HRD recommendations, adhering to the red meat, legumes, and fish recommendations was associated with lower T2D incidence. Meeting the recommendation of dairy and added sugars was associated with an increased incidence of T2D. Higher adherence to a diet designed to promote environmental and human health may help prevent T2D incidence among women in a middle-income country.
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Pinho-Gomes AC, Booth L, Pettigrew S. Public perceptions of responsibility for recommended food policies in seven countries. Eur J Public Health 2023; 33:299-304. [PMID: 36763587 PMCID: PMC10066496 DOI: 10.1093/eurpub/ckad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Food policy is important to promote healthy and sustainable diets. However, who is responsible for developing and implementing food policy remains contentious. Therefore, this study aimed to investigate how the public attributes responsibility for food policy to governments, individuals and the private sector. METHODS A total of 7559 respondents from seven countries [Australia (n = 1033), Canada (n = 1079), China (n = 1099), India (n = 1086), New Zealand (n = 1090), the UK (n = 1079) and the USA (n = 1093)] completed an online survey assessing perceived responsibility for 11 recommended food policies. RESULTS Overall, preferred responsibility for the assessed food policies was primarily attributed to governments (62%), followed by the private sector (49%) and individuals (31%). Respondents from New Zealand expressed the highest support for government responsibility (70%) and those from the USA the lowest (50%). Respondents from the USA and India were most likely to nominate individuals as responsible (both 37%), while those from China were least likely (23%). The private sector had the highest attributed responsibility in New Zealand (55%) and the lowest in China and the USA (both 47%). Support for government responsibility declined with age and was higher among those on higher incomes, with a university degree, and who perceived themselves to consume a healthy diet or be in poor health. CONCLUSIONS Across seven diverse countries, results indicate the public considers government should take primary responsibility for the assessed food policies, with modest contribution from the private sector and minority support for individual responsibility.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.,Institute of Health Informatics, University College London, London, UK
| | - Leon Booth
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Strid A, Johansson I, Lindahl B, Hallström E, Winkvist A. Toward a More Climate-Sustainable Diet: Possible Deleterious Impacts on Health When Diet Quality Is Ignored. J Nutr 2023; 153:242-252. [PMID: 36913458 DOI: 10.1016/j.tjnut.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/13/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets. OBJECTIVES To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs. METHODS Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact. RESULTS Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men. CONCLUSIONS The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.
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Affiliation(s)
- Anna Strid
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Bernt Lindahl
- Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Elinor Hallström
- Department of Agriculture and Food, RISE - Research Institutes of Sweden, Lund, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Kalmpourtzidou A, Scazzina F. Changes in terms of risks/benefits of shifting diets towards healthier and more sustainable dietary models. EFSA J 2022; 20:e200904. [DOI: 10.2903/j.efsa.2022.e200904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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27
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A scientific transition to support the 21st century dietary transition. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Craig MF. A plant based diet benefits personal and planetary health. BMJ 2022; 379:o2651. [PMID: 36351668 DOI: 10.1136/bmj.o2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Berthy F, Brunin J, Allès B, Fezeu LK, Touvier M, Hercberg S, Galan P, Pointereau P, Lairon D, Baudry J, Kesse-Guyot E. Association between adherence to the EAT-Lancet diet and risk of cancer and cardiovascular outcomes in the prospective NutriNet-Santé cohort. Am J Clin Nutr 2022; 116:980-991. [PMID: 35918246 DOI: 10.1093/ajcn/nqac208] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/29/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The EAT-Lancet commission proposed, in 2019, a planetary, healthy, and universal dietary pattern. However, this diet has rarely been studied in relation to various health outcomes. OBJECTIVES We aimed to prospectively estimate the association between the EAT-Lancet diet and cancer and cardiovascular disease (CVD) risk. METHODS The study was conducted in participants of the NutriNet-Santé cohort (2009-2021). The endpoints were the incident outcomes (cancer and CVDs and mortality from these diseases), combined and separately. Adherence to the EAT-Lancet diet was estimated using the EAT-Lancet Diet Index (ELD-I) modeled as quintiles (Qs). Multivariable Cox proportional hazard models were used to estimate HRs and 95% CIs, adjusted for potential confounders and moderators. RESULTS A total of 62,382 subjects were included; 2475 cases of cancer and 786 cases of cardiovascular events occurred during a median follow-up of 8.1 y. The sample was 76% female, the mean ± SD age at inclusion was 51.0 ± 10.2 y. The ELD-I ranged from -162 to 332 points with a mean ± SD score of 45.4 ± 25.6 points. In multivariable models, no significant association between the EAT-Lancet diet and the risk of cancer and CVD combined, and separately, was observed. Alcohol consumption was an effect modifier of the association. A significant association was observed among low drinkers (HRQ5vs.Q1: 0.86; 95% CI: 0.73, 1.02; P-trend = 0.02). A higher ELD-I was significantly associated with a lower risk of overall cancer only among females (HRQ5vs.Q1: 0.89; 95% CI: 0.75, 1.05; P-trend = 0.03). Both associations were largely attenuated by BMI. CONCLUSIONS Contrary to our hypothesis, our results documented significant associations between adherence to the EAT-Lancet diet and incidence of cancer only in some subgroups, and no association with CVD.This trial was registered at clinicaltrials.gov as NCT03335644.
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Affiliation(s)
- Florine Berthy
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Joséphine Brunin
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Benjamin Allès
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Léopold K Fezeu
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France.,Department of Public Health, Avicenne Hospital, Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | | | - Denis Lairon
- Aix Marseille University, INSERM, INRAE, C2VN, Marseille, France
| | - Julia Baudry
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
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Kommentar zu „Einhaltung der „EAT-Lancet
Diet“ senkt Mortalität“. AKTUELLE ERNÄHRUNGSMEDIZIN 2022. [DOI: 10.1055/a-1848-4295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Kann eine Ernährungsweise gleichzeitig gesundheitsförderlich
und nachhaltig sein? Diese Frage beschäftigt die
Ernährungsforschung seitdem die Eat-Lancet-Kommission 2019 ihr Konzept der
Planetary Health Diet (PHD) veröffentlichte 1. Diese Kostform soll die Ernährung für 10 Milliarden
Menschen im Jahr 2050 sichern. Sie wurde auf der Basis wissenschaftlicher
Erkenntnisse quasi am Reißbrett entworfen und definiert Mengenempfehlungen
für 7 Lebensmittelgruppen sowie für diverse Proteinquellen. Die
vorliegende Studie evaluiert innerhalb der schwedischen Malmö-Kohorte wie
sich die PHD auf das Mortalitätsrisiko auswirkt und zeigt
eindrücklich, dass es bei einer pflanzlich betonten Kost wie der PHD einen
Win-win-Effekt gibt: Nicht nur Klima und Umwelt profitieren sondern auch die
Gesundheit.
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Ohlau M, Spiller A, Risius A. Plant-Based Diets Are Not Enough? Understanding the Consumption of Plant-Based Meat Alternatives Along Ultra-processed Foods in Different Dietary Patterns in Germany. Front Nutr 2022; 9:852936. [PMID: 35571958 PMCID: PMC9094491 DOI: 10.3389/fnut.2022.852936] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/04/2022] [Indexed: 12/29/2022] Open
Abstract
A low-processive plant-based diet is considered valuable for a sustainable diet profile-it is supposed to meet health as well as environmental concerns. However, there is a growing trend toward plant-based meat alternatives, most of which are to be classified as ultra-processed food (UPF). The paper aimed to understand the consumption of different ultra-processed foods to describe their relation to dietary patterns and sustainability. The objective was (1) to depict the status-quo of consumption of plant-based meat alternatives along with other UPF groups (i.e., convenience products, fast foods, snacks, ultra-processed beverages) in a German sample (n = 814) and (2) to investigate the extent to which all examined UPFs are represented in different dietary patterns (vegetarian, flexitarian, regular meat-eaters, high meat-eaters). UPF intake and dietary groups were determined using a food frequency questionnaire (FFQ). Potential factors influencing UPF consumption, such as attitudes toward sustainability and healthy eating practices, were assessed using validated and fitted psychometric scales. Overall, the frequency of UPF consumption varies significantly along the product groups studied. Plant-based meat alternatives were the least consumed food (12.3%), followed by convenience products (57.4%), fast foods (55.9%), ultra-processed beverages (80.1%), and sweet and salty snacks (97.3%). Plant-based meat alternative consumption predominated within a vegetarian diet, while other UPFs, like convenience products, fast foods, sweet and salty snacks, and ultra-processed beverages, were mainly consumed by meat-eaters. Remarkably, flexitarian diets depict low consumption of all types of ultra-processed foods. In order to meet societal sustainability goals, diets and corresponding societal and political actions should emphasize not only plant orientation but also the increase of non- and low-processed foods.
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Affiliation(s)
- Marlene Ohlau
- Department of Agricultural Economics and Rural Development, University of Goettingen, Göttingen, Germany
| | - Achim Spiller
- Department of Agricultural Economics and Rural Development, University of Goettingen, Göttingen, Germany
| | - Antje Risius
- Department of Agricultural Economics and Rural Development, University of Goettingen, Göttingen, Germany
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Montejano Vallejo R, Schulz CA, van de Locht K, Oluwagbemigun K, Alexy U, Nöthlings U. Associations of Adherence to a Dietary Index Based on the EAT-Lancet Reference Diet with Nutritional, Anthropometric, and Ecological Sustainability Parameters: Results from the German DONALD Cohort Study. J Nutr 2022; 152:1763-1772. [PMID: 35554563 PMCID: PMC9258554 DOI: 10.1093/jn/nxac094] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Validation of the EAT-Lancet reference diet (ELR-diet), recently proposed by the EAT-Lancet Commission, within the context of real-life studies is necessary to elucidate its feasibility, nutritional value, sustainability, and health effects. OBJECTIVES We aimed to develop a dietary index (DI) score to measure adherence to the ELR-diet. We further aimed to study the association between the DI score and 1) nutritional characteristics, 2) indicators of ecological sustainability, and 3) anthropometric markers and biomarkers for cardiometabolic health. METHODS A DI score was constructed by comparing the categories defined by the ELR-diet with the dietary data of 2-5 sets of 3-d weighed dietary records from DONALD (Dortmund Nutritional and Anthropometric Longitudinal Designed) study participants (n = 298; ≥15 y of age). Prospective associations between the DI score and risk markers (anthropometric and cardiometabolic) in young adulthood (≥18 y old) were investigated using multivariate linear regression. RESULTS Adherence to the DI score components was considerable (majority > 50%), but varied within the population (2%-100%). The highest tertile of the DI score was inversely associated with the intake of protein (tertile 3 compared with tertile 1: 13.5 compared with 14.5 energy %), added sugars (10.5 compared with 12.4 energy %), and cholesterol (100 compared with 116 mg/1000 kcal), but positively associated with fiber intake (10.0 compared with 8.82 g/1000 kcal) (all P < 0.05). The DI score was inversely associated with greenhouse-gas emissions (tertile 1 compared with tertile 3: 6.48 compared with 5.85 kg of carbon dioxide equivalents/2500 kcal; P < 0.001) and land use (8.24 compared with 7.16 m2 × y/2500 kcal; P < 0.001). Inverse associations between the DI score and anthropometric markers during young adulthood were observed (e.g., BMI: tertile 1 compared with tertile 3: 22.9 compared with 21.9 kg/m2; P = 0.03) (all P < 0.05). No associations between the DI score and cardiometabolic risk markers were found (all P ≥ 0.05). CONCLUSIONS Adherence to the ELR-diet was associated with favorable nutritional characteristics and reduced environmental impact. Adherence to the DI score in adolescence was also beneficial with respect to anthropometric markers in early adulthood, although not for further cardiometabolic risk markers.
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Affiliation(s)
- Rebeca Montejano Vallejo
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | | | - Karen van de Locht
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Kolade Oluwagbemigun
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Ute Alexy
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Ute Nöthlings
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
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Plant-Based Dietary Patterns for Human and Planetary Health. Nutrients 2022; 14:nu14081614. [PMID: 35458176 PMCID: PMC9024616 DOI: 10.3390/nu14081614] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022] Open
Abstract
The coronavirus pandemic has acted as a reset on global economies, providing us with the opportunity to build back greener and ensure global warming does not surpass 1.5 °C. It is time for developed nations to commit to red meat reduction targets and shift to plant-based dietary patterns. Transitioning to plant-based diets (PBDs) has the potential to reduce diet-related land use by 76%, diet-related greenhouse gas emissions by 49%, eutrophication by 49%, and green and blue water use by 21% and 14%, respectively, whilst garnering substantial health co-benefits. An extensive body of data from prospective cohort studies and controlled trials supports the implementation of PBDs for obesity and chronic disease prevention. The consumption of diets high in fruits, vegetables, legumes, whole grains, nuts, fish, and unsaturated vegetable oils, and low in animal products, refined grains, and added sugars are associated with a lower risk of all-cause mortality. Meat appreciation, health concerns, convenience, and expense are prominent barriers to PBDs. Strategic policy action is required to overcome these barriers and promote the implementation of healthy and sustainable PBDs.
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González CA, Bonet C, Huerta JM, Amiano P, Ferrer MGR. Dietary greenhouse gas emissions and the risk of coronary heart disease and type 2 diabetes. Lancet Planet Health 2022; 6:e299. [PMID: 35397216 DOI: 10.1016/s2542-5196(22)00046-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Carlos A González
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL) Barcelona, Spain.
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL) Barcelona, Spain
| | - Jose María Huerta
- Center for Biomedical Research in Epidemiology and Public Health Network, Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain; Department of Health and Social Science, Universidad de Murcia, Murcia, Spain
| | - Pilar Amiano
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Guipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - Marta G Rivera Ferrer
- INGENIO (Spanish National Research Council and the Universitat Politècnica de València), Valencia, Spain
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Vineis P, Mangone L. The need for new metrics in the Anthropocene era. Front Public Health 2022; 10:935743. [PMID: 35991072 PMCID: PMC9386355 DOI: 10.3389/fpubh.2022.935743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
A limitation in the discussion concerning climate change is the large degree of separation between scientific, economic, and technological approaches to tackle the crisis. This issue is most noticeable when considering the lack of metrics to measure the impact of different productive sectors on both the environment and the health of the population. The best-known attempt to measure these repercussions has been the introduction of the Environmental, Social and Governance (ESG) ratings for bonds. However, this rating system suffers from a lack of transparency and standardization. Moreover, it does not offer insights on the health impact and the regenerative effort of the evaluated bonds. Thus, we think it is necessary to introduce new metrics, focusing on at least four dimensions: circularity, climate change, biodiversity and health (including well-being). A sector that needs a special consideration is that of energy. To better compare different energy sources, we propose to adjust metrics such as the Energy Return on Investment (EROI) or the energy intensity metrics to include the negative health effects and the environmental degradation associated with producing energy. A similar index of return on investment corrected for health impacts may be considered to evaluate food production as well. Hyper-analytical and extremely focused approaches have dominated the discussion around the environmental crisis. We believe that a more inclusive approach is now needed, to highlight the potential co-benefits of different strategies, especially those that promote regeneration and a truly circular economy.
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Affiliation(s)
- Paolo Vineis
- School of Public Health, Imperial College, Medical Research Council (MRC) Centre for Environment and Health, London, United Kingdom
| | - Lorenzo Mangone
- Sant'Anna School of Advanced Studies, Pisa, Italy.,Regenerative Society Foundation, Parma, Italy
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Sustainable Diets and Cancer: a Systematic Review. Curr Nutr Rep 2022; 11:742-752. [PMID: 36409441 PMCID: PMC9750932 DOI: 10.1007/s13668-022-00442-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE OF REVIEW This review aimed to investigate the association of sustainable diets in relation to cancer risk, cancer recurrence, and cancer-specific mortality in adults. RECENT FINDINGS More than 500 articles were initially identified. Nine articles were eligible for inclusion, presenting data from 8 prospective cohort studies, conducted in Europe and the USA. The sustainability indicators investigated were greenhouse gas emissions, food biodiversity, land use, exposure to pesticides or organic food consumption, and the EAT-Lancet diet. One study reported a sustainability index that combined multiple sustainability indicators. A modest inverse association between higher adherence to sustainable diets and cancer incidence or cancer mortality was observed in most studies. While sustainable diets may decrease cancer risk or mortality, the reviewed studies were heterogeneous regarding sustainability indicators and cancer outcomes. A common definition of dietary sustainability would facilitate better generalization of future research findings. Also, studies among non-western populations are needed.
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Stubbendorff A, Sonestedt E, Ramne S, Drake I, Hallström E, Ericson U. Development of an EAT-Lancet index and its relation to mortality in a Swedish population. Am J Clin Nutr 2021; 115:705-716. [PMID: 34791011 PMCID: PMC8895215 DOI: 10.1093/ajcn/nqab369] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current global food systems threaten human health and environmental sustainability. In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems defined the first global reference diet to improve both areas, but there is no consensus on how to quantify the EAT-Lancet reference diet as a diet index, and its relation to mortality has not been widely studied. OBJECTIVES We sought to develop a new dietary index to quantify adherence to the EAT-Lancet diet and assess its association with mortality in a large, population-based Swedish cohort. We also examined food components included in the index and their individual associations with mortality. METHODS We used the Malmö Diet and Cancer cohort (n = 22,421; 45-73 years old at baseline). Dietary data were collected using a modified diet history method. The EAT-Lancet index was developed based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0-3 points per component; 0-42 points in total). Associations with mortality were examined based on registers during a mean of 20 years of follow-up and were adjusted for potential confounders. RESULTS Divided into 5 adherence groups, the highest adherence to the EAT-Lancet diet (≥23 points) was associated with lower all-cause mortality (HR, 0.75; 95% CI, 0.67-0.85), cancer mortality (HR, 0.76; 95% CI, 0.63-0.92), and cardiovascular mortality (HR, 0.68; 95% CI, 0.54-0.84) than the lowest adherence (≤13 points). Several food components included in the index contributed to the observed reductions in mortality. CONCLUSIONS We developed a new dietary index to investigate adherence to the EAT-Lancet diet. The findings indicate a 25% lower risk of mortality among those with the highest adherence to the EAT-Lancet diet, as defined using our index, which adds to the evidence base for the development of sustainable dietary guidelines.
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Affiliation(s)
| | - Emily Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Stina Ramne
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Isabel Drake
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Elinor Hallström
- Department of Agriculture and Food, Research Institutes of Sweden (RISE), Lund, Sweden
| | - Ulrika Ericson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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