The Water Footprint of Diets: A Global Systematic Review and Meta-analysis

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Exploring Australian News Media Portrayals of Sustainable and Plant-Based Diets

(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.

Traditional japanese diet score and the sustainable development goals by a global comparative ecological study

BACKGROUND

Reducing the environmental impact of the food supply is important for achieving Sustainable Development Goals (SDGs) worldwide. Previously, we developed the Traditional Japanese Diet Score (TJDS) and reported in a global ecological study that the Japanese diet is associated with reducing obesity and extending healthy life expectancy etc. We then examined the relationship between the TJDS and environmental indicators.

METHODS

The average food (g/day/capita) and energy supplies (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. The TJDS was calculated from eight food groups (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, and eggs; food components that are relatively unused in the traditional Japanese diet: wheat, milk, and red meat) by country using tertiles, and calculated the total score from - 8 to 8, with higher scores meaning greater adherence to the TJDS. We used Land Use (m2), Greenhouse gas (GHG) emissions 2007/2013 (kg CO2eq), Acidifying emissions (g SO2eq), Eutrophying emissions (g PO43- eq), Freshwater (L), and water use (L) per food weight by Poore et al. as the environmental indicators and multiplied these indicators by each country's average food supply. We evaluated the cross-sectional and longitudinal associations between the TJDS and environmental indicators from 2010 to 2020. This study included 151 countries with populations ≥ 1 million.

RESULTS

Land use (β ± standard error; -0.623 ± 0.161, p < 0.001), GHG 2007 (-0.149 ± 0.057, p < 0.05), GHG 2013 (-0.183 ± 0.066, p < 0.01), Acidifying (-1.111 ± 0.369, p < 0.01), and Water use (-405.903 ± 101.416, p < 0.001) were negatively associated with TJDS, and Freshwater (45.116 ± 7.866, p < 0.001) was positively associated with TJDS after controlling for energy supply and latitude in 2010. In the longitudinal analysis, Land Use (β ± standard error; -0.116 ± 0.027, p < 0.001), GHG 2007 (-0.040 ± 0.010, p < 0.001), GHG 2013 (-0.048 ± 0.011, p < 0.001), Acidifying (-0.280 ± 0.064, p < 0.001), Eutrophying (-0.132 ± 0.062, p < 0.05), and Water use (-118.246 ± 22.826, p < 0.001) were negatively associated with TJDS after controlling for confounders.

CONCLUSIONS

This ecological study suggests that the traditional Japanese dietary pattern might improve SDGs except Fresh water.

Select dietary changes towards sustainability: Impacts on dietary profiles, environmental footprint, and cost

Healthy sustainable diets have the power to improve dietary intakes and environmental resource use. However, recommendations for improving food choices need to consider the effects of any changes across multiple dimensions of health, environmental sustainability, and dietary cost to promote long-lasting behaviour change. The aim of this study was to identify differences between original diets, and the diets that can be achieved through the implementation of select small dietary changes towards sustainability. Twelve hypothetical sustainable actions were investigated for the potential effects of these actions on dietary markers (protein, saturated fat, sugars, salt, iron, and calcium), environmental footprints (greenhouse gas emissions, freshwater withdrawals, and land use), and dietary cost. Dietary data from 1235 individuals, aged 19-94 years, participating in the UK National Diet and Nutrition Survey (2017/19) provided the original diet. Dietary changes were implemented as required by each sustainable action, and differences between the original diet and each new diet were investigated. Results revealed benefits to dietary markers and environmental characteristics from eleven sustainable actions (range: F(1,728) = 5.80, p < .001 to F(1,506) = 435.04, p < .001), but effects were stronger for some actions than for others. Greatest benefits for all three outcomes were found for actions which reduced meat consumption and/or replaced meat with pulses or eggs. The remaining sustainable actions tended to be beneficial for improving outcomes individually or to some degree. Our results demonstrate the possible impacts of a number of small sustainable dietary actions for dietary, environmental, and cost outcomes, and provide a hierarchy of actions based on benefit. Findings may facilitate dietary behaviours towards improved health, whilst also offering fruitful contributions towards environmental footprint targets in the UK.

Wastewater recovery for sustainable agricultural systems in the circular economy - A systematic literature review of Life Cycle Assessments

Water availability and quality are known to affect agricultural production and nutrition. The aim of this study was to elaborate a systematic literature review of the most sustainable ways of wastewater treatment towards achieving circular economy (CE) in agro-industry activities. From the SLR, the authors selected twenty-seven papers that they classified into the three research themes of recovery of wastewater into irrigation water, extraction of sludge for production of bio-based compounds, and recovery of nutrients for soil amendment, including recovering of feeds for aquaculture, and recovery of nutrient biosolids for soil amendment. Results underlined that the recovery of nutrients biosolids for soil amendment can generate a GWP gain up to - 37 kg CO2-eq. So, the review highlighted that wastewater recovery for multiple purposes can be truly effective for the environmental sustainability of agricultural systems, and that LCA is a valid tool to assess and improve that sustainability. Under this perspective, this SLR's findings can stimulate public administrations at national and local scales in their planning and funding activities towards implementing circular bioeconomy paths based upon wastewater recovery for a sustainable, resilient agriculture. Overall, the authors believe that their article was effective in overviewing the current wastewater recovery paths in the CE context, and in highlighting key methodological aspects and findings of the reviewed LCAs, to advance the specialised literature and knowledge, and to guide practitioners for future LCA applications in the field. Finally, through its main findings, the article effectively contributes to the whole research project which it is part of and which the authors are deeply involved in. That research is performed under the Progetto GRINS "Growing Resilient, Inclusive and Sustainable" thanks to a PNRR M4C2- Investment 1.3 - GRINS with the aim of "Building a dataset for the circular economy of the main Italian production systems".

Evaluation of personal water footprint components in Turkey: factors associated with obesity and food consumption

This study aimed to evaluate the personal water footprint individuals, and was conducted with 3431 individuals İbetween 18-95 years. A questionnaire form included questions about demographic characteristics, anthropometric measurements, and food consumption was applied. The "Extended Water Footprint Calculator" was used to evaluate the personal water footprint, and various questions were asked to determine the components of food consumption, domestic water, and industrial water use. The average age of the participants was 34.6 ± 13.93 years. The total water footprint of the male was significantly higher than the female. The total water footprint of individuals between the ages of 41-64 was higher than other age groups, and also obese individuals had the highest total water footprint (p < 0.05). Meat and meat products contributed the most to the total water footprint. Having a normal body weight and adopting more sustainable dietary patterns should be emphasized because of their impacts on the environment and health.

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

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.

Evaluation of the Turkey Nutrition and Health Surveys according to the mediterranean adequacy index and sustainability through water footprints

OBJECTIVE

Sustainable diet is one of the main factors that support food security, and the Mediterranean diet (MD) one of the sustainable diet models associated with low ecological impact and optimum health results has come to the fore. It was aimed to compare the results of the 2010 and 2017 Turkey Nutrition and Health Studies (TNHS) according to the Mediterranean Adequacy Index (MAI) and in order to evaluate the environmental impact of the current nutritional status in Turkey through water footprints (WF).

DESIGN

The MAI score was calculated using the published results of the 2010 and 2017 TNHS, and the WF have been calculated as indicators of environmental impact.

SETTING

Turkey.

PARTICIPANTS

There are no participants.

RESULTS

In the TNHS, there was an increase in the amount of energy provided by foods non-MD in 2017 compared to 2010, with a decrease in the total MAI score. The group with the lowest adherence to the MD in both years was the adult group (MAI20102·74 and MAI20172·31), while the group with the highest adherence was the adolescent group (MAI20103·21 and MAI20172·53). The MAI scores of females were higher than those of males in both years. The males aged 19-64 years had the largest (841 m3/year) WF and the females aged 65+ years had the smallest (483 m3/year). The food group that contributed the most to WF was meat and meat products (21·0-35·0 %).

CONCLUSIONS

Adherence to the MD has decreased due to the increase in the consumption of the Western-type diet in Turkey.

Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability

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.

Water scarcity in agriculture: An overview of causes, impacts and approaches for reducing the risks

Freshwater is a vital resource for both ecosystem health and human survival, and it is the natural resource that is the most extracted at the global level. Excessive freshwater consumption can be responsible for a scarcity in the circulation rate, which occurs when the freshwater demand exceeds its availability. Hence, water consumption needs to be optimised in all human activities, given the increasing freshwater scarcity due to climate changes and to the annual net increase in the human population of 81,000,000. Freshwater plays many important roles in daily life for example, agriculture is responsible for nearly 70% of that withdrawal volume, and it is therefore, the most water-intensive sector. This puts emphasis upon the urgent need of transitioning towards more sustainable agricultural and food-production/consumption systems. Water Footprint (WF) is increasingly playing a guiding role in that context. Indeed, it makes it possible to quantify water consumption and related environmental consequences. With the objective of contributing to enhancement of research and of supporting practitioners and decision-makers in environmentally sustainable and resilient food production/consumption, the authors of this article addressed the relevant issues connected with: a) physical and economic water scarcity in agriculture, b) practices and tools to reduce water wastage, c) WF assessment methodologies. A number of environmental, economic, and engineering solutions were proposed to mitigate water scarcity. The improvement of irrigation technologies and practices was identified as an important major way to reduce water scarcity. Additionally, solar powered 'reverse-osmosis' is being used in many parts of the world to produce irrigation water from saline water, thereby reducing the need to extract freshwater from underground aquifers. This article confirmed the importance of research on water scarcity; moreover, it can stimulate development and application of solutions that make agricultural production/consumption more efficient and resilient.

Insight into the Sustainability of the Mediterranean Diet: The Water Footprint of the Recommended Italian Diet

At present, as we face climate change and natural resource scarcity, one of the major challenges linking humans and the environment is to ensure sufficient, nutritious, safe, and affordable food for a rapidly growing world population. In a nutshell, "feed the world without destroying it". The water footprint (WF), i.e., the withdrawals of fresh water necessary to produce one kilogram of food product, is one of the key indicators of the environmental impact of diets. In this work, the WF of the food patterns suggested by the Italian Food Based Dietary Guidelines, considered a model of the Mediterranean Diet, was evaluated for the first time. The data reported here clearly demonstrate that the suggested Italian dietary patterns have a low WF, the reduction of which by replacing animal foods with plant foods is limited because the suggested consumption of meat is already low. Consumer choice in the consumption of specific products within a food group could further reduce the WF of the diet, underlining the need to provide correct information not only to consumers but also to farmers and producers to encourage them to make water-saving choices.

Believe It or 'Nut': Why It Is Time to Set the Record Straight on Nut Protein Quality: Pistachio (Pistacia vera L.) Focus

There are growing public health movements to transition towards diets that are plant-based. However, confusion exists with concerns that plant-based proteins (including nuts) may be inferior with respect to protein quality. The present publication evaluates the evolution of protein quality concepts and explains the protein science related to pistachios. Pistachio nuts are a plant-based complete protein providing all nine EAAs in addition to an array of nutrients and phytochemicals. They have a PDCAAS of 73 and 81%, (raw and roasted pistachios, respectively), higher than that of many other tree nuts. From an environmental perspective transitioning towards plant-based diets (including nuts) could have potential to reduce total/green water footprints. Dietary guidelines are evolving yet nuts such as pistachios do not always have a clear place within these. Now appears to be a pertinent time to look at protein quality from the perspective of whole daily diets and dietary patterns, factoring in both health and environmental outcomes. Given updated modes of thinking, nuts such as pistachios have an important role to play in terms of providing ready-to-eat, good-quality, plant-based protein within daily diets.

Is high adaptation to the Mediterranean diet effective in increasing ecological footprint awareness? A cross-sectional study from Turkey

BACKGROUND

The effect of diet type on sustainable environment is known. It is important to understand the adaptation of individuals with high ecological footprint awareness to the Mediterranean type diet, especially under the assumption that the Mediterranean diet will reduce the ecological footprint. In the study, it is aimed to examine the relationship between the level of adherence to the Mediterranean diet and Ecological Footprint awareness of adults.

RESULTS

The sample of the study consisted of 395 individuals with a mean age of 26.2 ± 8.7 years: 293 females (74.2%) and 102 males (25.8%). As the Mediterranean Diet Adherence Scale (MDAS) score of individuals increased, the Ecological Footprint Awareness Scale score also increased. Similarly, a positive correlation was found between the participants' MDAS score and the awareness of food (r = 0.157; P = 0.002), energy (r = 0.133; P = 0.008), waste (r = 0.149; P = 0.003) and water consumption (r = 0.101; P = 0.045), which are sub-factors of the Ecological Footprint Awareness Scale.

CONCLUSION

As far as is known, this cross-sectional study is one of the first studies on compliance with the Mediterranean diet and awareness of the ecological footprint. The findings of the study show that as individuals' compliance with the Mediterranean diet increases, their awareness of their ecological footprint will also increase. To reach a conclusion on this issue, future studies should evaluate the relationship between adherence to the Mediterranean diet and awareness of food-environmental impact on different samples. © 2021 Society of Chemical Industry.

Changes in Climate Vulnerability and Projected Water Stress of The Gambia's Food Supply Between 1988 and 2018: Trading With Trade-Offs

Background

The coexistence of under- and overnutrition is of increasing public health concern in The Gambia. Fruits, vegetables and pulses are essential to healthy and sustainable diets, preventing micronutrient deficiencies and non-communicable diseases, while cereals significantly contribute to energy intake. However, environmental changes are predicted to intensify, reducing future yields of these crops if agricultural productivity and resilience are not improved. The Gambia is highly climate-vulnerable and import-dependent, but the extent of its reliance on other climate-vulnerable countries for its supply of nutritionally important crops is currently unknown.

Methods

We used United Nations Food and Agriculture Organization data, with novel origin-tracing algorithms applied, to analyse The Gambia's supply of cereals, fruits, vegetables and pulses between 1988 and 2018. The climate vulnerability of countries was assessed using Notre Dame Global Adaptation Initiative (ND-GAIN) index scores, and projected water stress (2040) assessed using World Resources Institute (WRI) scores. Multilevel generalized linear mixed-effects models were used to identify changes in the overall climate vulnerability and projected water stress of supply.

Results

Between 1988 and 2018, The Gambia's supply of cereals, fruits, vegetables and pulses diversified, with the proportion domestically produced falling (Cereals: 61.4%-27.7%; Fruits: 93.0%-55.7%; Vegetables: 24.6%-16.3%; Pulses: 100.0%-76.0%). The weighted-average ND-GAIN scores improved (indicating less climate vulnerability) for supply of all crops except cereals, but the weighted-average WRI score for supply deteriorated (indicating increased projected water stress) for all crops except vegetables. When just considering imports, weighted-average ND-GAIN scores deteriorated for fruits and cereals while showing no significant change for other food groups, and the WRI score deteriorated for cereals only.

Conclusions

Despite some notable improvements in the environmental vulnerability of The Gambia's supply of nutritionally important crops (particularly vegetables), considerable, and in some cases increasing, proportions of their supply are produced in countries that are vulnerable to climate change and future water stress. This may have implications for the availability, affordability, and hence consumption of these crops in The Gambia, ultimately exacerbating existing nutritional challenges. Exploring the options to strengthen supply resilience-such as altering trade patterns, agricultural techniques and diets-should be prioritized.

Water Footprint as a Tool for Selection of Alternatives (Comments on “Food Recommendations for Reducing Water Footprint”)

Water footprint is a new tool for assessing sustainability in terms of water use. Researchers are devising new applications that use water footprint, one of which is focused on comparing the water requirements of individual diets. Systems have been proposed to suggest tailor-made recipes that use a lower water quantity in production. This system proposes alternative recipes with lower demands for water resources based on their water footprint. The water footprint consists of three components—blue, green, and grey water footprints. However, focusing only on a reduction in the total water footprint may lead to an increase in some of its parts, such as the blue water footprint, and subsequently to water scarcity in some river basins. Therefore, it is recommended to extend the food recommendations system with sustainability criteria in order to avoid the unsustainable management of water resources. The same criteria can be used in any system for selecting alternatives based on the water footprint.

The Environmental Footprint Associated With the Mediterranean Diet, EAT-Lancet Diet, and the Sustainable Healthy Diet Index: A Population-Based Study

Providing a growing global population with healthy and sustainable diets is an immediate challenge. In the current study, estimates were obtained for the environmental footprints (land, water, and greenhouse gas (GHG) emissions) in association with the Mediterranean diet (MED) and the EAT-Lancet reference diet, which represents a healthy diet derived from sustainable food systems. We used a newly developed Sustainable Healthy Diet (SHED) index that was validated for the Israeli population by Tepper et al. in 2020.

The water footprint and nutritional implications of diet change in Mexico: a principal component analysis

PURPOSE

Nutrition transition (NT) has modified the way that the Mexican population eats, while their body composition has also been modified. These changes have been linked with environmental impacts; however, little is known regarding water footprint (WF). The objective of this paper was to analyze the NT process in Mexico and evaluate its impact on WF using principal component analysis (PCA).

METHODS

A validated Food Consumption Frequency Questionnaire (FCFQ) was modified and applied to 400 adults from the Metropolitan Zone of Guadalajara, Mexico. The WF was calculated according to the WF Assessment Method. PCA and tertiles analysis was carried out to define dietary patterns WFs (DPWF). Questions covering sociodemographic and socioeconomic factors, as well as body composition data and physical activity levels were measured.

RESULTS

The average DPWF was 6619.58 ± 3182.62 L per person per day (L p^-1d^-1). We found three DPWF by PCA: Medium NT (55% from the total sample), Healthy plant-based (28%), and High in animal protein (17%). The highest energy consumption, western and Mexican foods intake, and dietary WF were found in Medium NT DPWF, as well as obesity prevalence. Fruits and vegetable consumption was higher in Healthy plant-based DPWF. Muscle mass percentage was higher in the High in animal protein DPWF.

CONCLUSIONS

Although most of the population is currently on Medium NT, new dietary patterns have emerged, where there was found a trend to plant-based diets but also diets high in animal food sources that can influence nutritional status.

Sustainable Diet Optimization Targeting Dietary Water Footprint Reduction—A Country-Specific Study

Food production creates 70% of the total anthropogenic water footprint, and it is the main cause of water pollution. Thus, more sustainable diets could contribute to the achievement of the Sustainable Development Goals. A linear programming-based stepwise optimization was designed to create dietary water footprint-reduced, culturally acceptable, and healthier diets in the case of Hungary based on a representative dietary survey. Optimization resulted in a considerable total dietary water footprint reduction (women: 18%; men: 28%) with a moderate dietary shift (~32%). Milk and dairies (observed: ~31.5%, optimized: ~20.5%) and meats and meat products (observed: ~28.0%, optimized: 28.9%) contributed the most to the dietary water footprint. In the water footprint–healthiness synergy, the vegetables, eggs, poultries, and fermented dairies were the most beneficial, increasing in amount, while fatty dairies, foods high in added sugar, and meat products were the most non-beneficial food sub-groups, decreasing in amount in the optimized diets. The problematic nutrients to fulfill in the optimized diets were energy, dietary fibers, sodium, vitamin D, zinc, vitamin B12, calcium, iron, and potassium at the maximum water footprint reduction. The study provides supporting evidence about the dietary water footprint–healthiness synergy for the further improvement of the national food-based dietary guideline.

Driving commitment to sustainable food policies within the framework of American and European dietary guidelines

Diet and nutrition are essential factors in promoting good health throughout life. Their role as determinants of chronic non-communicable diseases is widely recognized. Additionally, the demand for food involves relevant environmental burdens that have to be taken into account on the way to achieving the Sustainable Development Goals. As an important part of nutrition policy, food-based dietary guidelines (FBDGs) have been revised. The key question is: Are environmental considerations being incorporated into them? To address this issue, we modeled and compared both the main environmental indicators in terms of carbon footprint (CF) and water footprint (WF), and nutritional quality (according to the Nutrient Rich Diet index, NRD9.3 and a health gain score) of dietary guidelines from Northern and Southern Europe and America. Particularly, the FBDGs compared were Dutch Dietary Guidelines (DDG), New Nordic Diet (NND), Spanish Strategy for Nutrition, Physical Activity and Obesity Prevention (NAOS), Mediterranean Diet (MD), Italian Dietary Guidelines (IDG) and American Dietary Guidelines (DGA). The IDG and MD offered the best profiles from a climate change perspective (2.04 and 2.21 kgCO₂eq·day^-1). Overall, DGA had the highest CF (2.98 kgCO₂eq·day^-1). WF presented greater fluctuations, not only due to daily-recommended amounts, but also because of different climate conditions and production systems of the reference countries. Hence, WF ranged from 1760 L·person^-1·day^-1 in IDG to 3181 L·person^-1·day^-1 in NAOS. Finally, the nutritional value of MD, which had the highest NRD9.3 (477) and health gain score (178), has been demonstrated when the comparison was made with DDG, the one with the lowest health gain score (97) and DGA, the worst in terms of NRD9.3 (391). To go ahead of the FBDGs that bet on all dimensions of sustainability, multi-criteria analysis is needed. Nutrition and environmental performance are not the only aspects of the problem; economy and sociocultural variables should be considered.

Determinants of Food Consumption Water Footprint in the MENA Region: The Case of Tunisia

Tunisia, like most countries in the Middle East and North Africa (MENA) region, has limited renewable water resources and is classified as a water stress country. The effects of climate change are exacerbating the situation. The agricultural sector is the main consumer (80%) of blue water reserves. In this study, to better understand the factors that influence the food water footprint of Tunisian consumers, we used a multiple linear regression model (MLR) to analyze data from 4853 households. The innovation in this paper consists of integrating effects of socio-economic, demographic, and geographic trends on the food consumption water footprint into the assessment of water and food security. The model results showed that regional variations in food choices meant large differences in water footprints, as hypothesized. Residents of big cities are more likely to have a large water footprint. Significant variability in water footprints, due to different food consumption patterns and socio-demographic characteristics, was also noted. Food waste is also one of the determining factors of households with a high water footprint. This study provides a new perspective on the water footprint of food consumption using “household” level data. These dietary water footprint estimates can be used to assess potential water demand scenarios as food consumption patterns change. Analysis at the geographic and socio-demographic levels helps to inform policy makers by identifying realistic dietary changes.

A Scoping Review of Indicators for Sustainable Healthy Diets

Introduction: Diets are currently unsustainable in many countries as evidenced by the growing burden of malnutrition, degradation of natural resources, contributions to climate change, and unaffordability of healthy diets. Agreement on what constitutes a healthy and sustainable diet has been debated. In 2019, FAO and WHO published the Sustainable Healthy Diets Guiding Principles, defining what qualifies as a sustainable healthy diet. While valuable, these principles require measurable indicators to support their operationalization. Our scoping review aims to describe how sustainable healthy diets have been assessed in the literature since 2010.

Methods: A search for English-language articles published in peer-reviewed journals was conducted from January 2010 through February 2020 across three databases. Out of the 504 articles initially identified, 103 articles were included. Metadata were extracted from each article on: publication year, country of study, study aims, methods, main data sources, indicators used to assess sustainable healthy diets, reported indicator strengths or limitations, and main study findings. A qualitative content analysis identified major conceptual themes across indicators and their frequency of use.

Findings: From the 103 empirical articles included in our review, 57.3% were published after 2017. Most studies were carried out in high-income countries (74%). Approximately 42% of the articles assessed the sustainability of diets using solely health and environmental indicators; &lt;25% assessed the sustainability of diets across health, environmental, and sociocultural aspects of sustainability. We found a substantial number of unique indicators used for assessing health (n = 82), environmental (n = 117), and sociocultural (n = 43) aspects of diets. These indicators covered concepts related to health outcomes, aspects of diet quality, natural resources, climate change, cultural acceptability, and cost of diets. The preponderance of indicators currently used in research likely poses challenges for stakeholders to identify the most appropriate measures.

Conclusion: Robust indicators for sustainable healthy diets are critical for understanding trends, setting targets, and monitoring progress across national and sub-national levels. Our review highlights the geographical imbalance, the narrow focus on health and environmental aspects, and the lack of common measures used in research. Measures registries could provide the decision-support needed by stakeholders to aid in the indicator selection process.

The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable

The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.

Quality and environmental footprints of diets by socio-economic status in Argentina

Food consumption and production plays a major role on human health and environmental sustainability. In addition, socio-economic status (SES) could be an important determinant on these impacts. Here we investigated the quality and environmental footprints of diets of different SES in Argentina. Dietary data was obtained from a recent national-wide representative survey (21,547 households), and individual intake was estimated by applying the Adult-Male Equivalent (AME) approach. Dietary quality was assessed by comparing the apparent consumption of foods and nutrients with the level of intake associated with the lowest risk of mortality, and applying the Alternate Healthy Eating Index 2010 (AHEI-2010). The environmental footprints were assessed with a set of six environmental indicators: greenhouse gas (GHG) emissions, total land occupation, cropland demand, fossil energy use, freshwater consumption and eutrophying emissions. Per capita total expenditure was utilized as an indicator of SES. We found a suboptimal intake of healthy and excess of unhealthy foods and nutrients in all SES, as well as a low AHEI-2010 score (34.7 ± 3.56 over 100). Regarding environmental footprints per AME, we estimated 8.91 ± 2.49 kg CO₂-eq/day for GHG emissions, 9.30 ± 2.93 MJ/day for fossil energy use, 54.2 ± 14.8 m²/day for total land occupation, 7.07 ± 1.90 m²/day for cropland demand, 205 ± 65.3 L/day for freshwater consumption and 19.8 ± 6.43 g PO₄-eq/day for eutrophying emissions. The Argentinian diet was found to be both unhealthy and unsustainable in all socio-economic levels.

Disparities and drivers of the water footprint of food consumption in China

Food production requires a large amount of water. As a country facing a serious scarcity of per capita water resources and severe water pollution, China must explore the spatial distribution characteristics of its dietary water footprint. China is the world's largest developing country, and water consumption inevitably has increased with its economic development. It is essential to explore the factors influencing the water footprint and water conservation mechanisms. Based on China Health and Nutrition Survey (CHNS) data, individual-level data of dietary water footprint and residents' socio-economic characteristics were obtained. The decision tree was applied to classify the dietary water footprint based on socio-economic factors, and multinomial logistic regression was then performed to investigate the influence of each factor. The results showed that all six selected socio-economic factors had a statistically significant impact on the dietary water footprint. Income and education level were positively related to the dietary water footprint; urban residents, males, and residents with a higher body mass index (BMI) consumed more dietary water than rural residents, females, and those with a lower BMI, respectively. Age exhibited an inverted U-shaped influence. Understanding the drivers and disparities of the water footprint of food consumption can support the development of policy for energy conservation, which can ultimately help achieve the goal of reducing water waste.

Which diet has the lower water footprint in Mediterranean countries?

The Mediterranean region is increasingly water scarce, with the food system being the largest driver of water use. We calculate the water resources related to food consumption in nine major Mediterranean countries, by means of the water footprint (WF), for the existing situation (period 2011-2013) as well as the Mediterranean and EAT-Lancet diets. We account for different food intake requirements according to gender and six age groups. These nine countries - Spain, France, Italy, Greece, Turkey, Egypt, Tunisia, Algeria and Morocco - represent 88% of the population of all countries bordering the Mediterranean. As first major observation, we find that the EAT-Lancet diet, a scientifically optimised diet for both nutrition and certain environmental indicators, requires less water resources than the Mediterranean diet, a culturally accepted diet within the region. In terms of water resources use, adherence to the former is thus more beneficial than adherence to the latter. As second major observation, we find that the EAT-Lancet diet reduces the current WF for all nations consistently, within the range -17% to -48%, whereas the Mediterranean diet reduces the WF of the European countries, Turkey, Egypt and Morocco within the range of -4% to -35%. For the Maghreb countries Tunisia and Algeria, the Mediterranean diet WF is slightly higher compared to the current WF and the proportions of food product groups differ. Such dietary shifts would be important parts of the solution to obtain the sustainable use of water resources in Mediterranean countries.

Perspective: The Importance of Water Security for Ensuring Food Security, Good Nutrition, and Well-being

Water security is a powerful concept that is still in its early days in the field of nutrition. Given the prevalence and severity of water issues and the many interconnections between water and nutrition, we argue that water security deserves attention commensurate with its importance to human nutrition and health. To this end, we first give a brief introduction to water insecurity and discuss its conceptualization in terms of availability, access, use, and stability. We then lay out the empirical grounding for its assessment. Parallels to the food-security literature are drawn throughout, both because the concepts are analogous and food security is familiar to the nutrition community. Specifically, we review the evolution of scales to measure water and food security and compare select characteristics. We then review the burgeoning evidence for the causes and consequences of water insecurity and conclude with 4 recommendations: 1) collect more water-insecurity data (i.e., on prevalence, causes, consequences, and intervention impacts); 2) collect better data on water insecurity (i.e., measure it concurrently with food security and other nutritional indicators, measure intrahousehold variation, and establish baseline indicators of both water and nutrition before interventions are implemented); 3) consider food and water issues jointly in policy and practice (e.g., establish linkages and possibilities for joint interventions, recognize the environmental footprint of nutritional guidelines, strengthen the nutrition sensitivity of water-management practices, and use experience-based scales for improving governance and regulation across food and water systems); and 4) make findings easily available so that they can be used by the media, community organizations, and other scientists for advocacy and in governance (e.g., tracking progress towards development goals and holding implementers accountable). As recognition of the importance of water security grows, we hope that so too will the prioritization of water in nutrition research, funding, and policy.

Modelling land system evolution and dynamics of terrestrial carbon stocks in the Luanhe River Basin, China: a scenario analysis of trade-offs and synergies between sustainable development goals

A more holistic understanding of land use and land cover (LULC) will help minimise trade-offs and maximise synergies, and lead to improved future land use management strategies for the attainment of Sustainable Development Goals (SDGs). However, current assessments of future LULC changes rarely focus on the multiple demands for goods and services, which are related to the synergies and trade-offs between SDGs and their targets. In this study, the land system (combinations of land cover and land use intensity) evolution trajectories of the Luanhe River Basin (LRB), China, and major challenges that the LRB may face in 2030, were explored by applying the CLUMondo and InVEST models. The results indicate that the LRB is likely to experience agricultural intensification and urban growth under all four scenarios that were explored. The cropland intensity and the urban growth rate were much higher under the historical trend (Trend) scenario compared to those with more planning interventions (Expansion, Sustainability, and Conservation scenarios). Unless the forest area and biodiversity conservation targets are implemented (Conservation scenario), the forest areas are projected to decrease by 2030. The results indicate that water scarcity in the LRB is likely to increase under all scenarios, and the carbon storage will increase under the Conservation scenario but decrease under all other scenarios by 2030. Our methodological framework and findings can guide regional sustainable development in the LRB and other large river basins in China, and will be valuable for policy and planning purposes to the pursuance of SDGs at the sub-national scale.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11625-021-01004-y.

Eat Well to Fight Obesity… and Save Water: The Water Footprint of Different Diets and Caloric Intake and Its Relationship With Adiposity

Water scarcity and excess adiposity are two of the main problems worldwide and in Mexico, which is the most obese country in the world and suffers from water scarcity. Food production represents 90% of a person's water footprint (WF), and healthy diets can lead to less WF than do unhealthy diets related to obesity. We calculated the WF of the diet and caloric intake of adults in Mexico and analyzed its relationship with adiposity. Also, the risk of water expenditure due to adiposity and adherence to dietary recommendations regarding WF of international healthy diets were examined. A Food Consumption Frequency Questionnaire (FCFQ) was applied to 395 adults. Body mass index (BMI), associated with adiposity indicators, was used as a reference for grouping a sample into adiposity levels. The WF was calculated according to the WF Assessment Method, considering correction factors and accounting for water involved in cooking and food washing. Our results showed that the Mexican diet spends 6,056 liters per person per day (L p-1d-1) and is 55% higher than international healthy diets WF. Consumption of beef, milk, fruits, chicken, and fatty cereals represented 56% of total WF. Strong relations appeared between hypercaloric diets and high WF. Diets of people with excess adiposity generated statistically higher WF with extra expenses of 729 L p-1d-1 compared with the normal adiposity population. Following nutritional recommendations offers a protective factor in water care, whereas not adhering to these represents a risk up to 93 times greater of water expenditure regarding international healthy diets. Therefore, both for the general population and to regulate obesity, adequate diets can help mitigate the problem of water scarcity.

A multilevel carbon and water footprint dataset of food commodities

Informing and engaging citizens to adopt sustainable diets is a key strategy for reducing global environmental impacts of the agricultural and food sectors. In this respect, the first requisite to support citizens and actors of the food sector is to provide them a publicly available, reliable and ready to use synthesis of environmental pressures associated to food commodities. Here we introduce the SU-EATABLE LIFE database, a multilevel database of carbon (CF) and water (WF) footprint values of food commodities, based on a standardized methodology to extract information and assign optimal footprint values and uncertainties to food items, starting from peer-reviewed articles and grey literature. The database and its innovative methodological framework for uncertainty treatment and data quality assurance provides a solid basis for evaluating the impact of dietary shifts on global environmental policies, including climate mitigation through greenhouse gas emission reductions. The database ensures repeatability and further expansion, providing a reliable science-based tool for managers and researcher in the food sector.

Measurement(s)	carbon footprint of food products and related uncertainties • water footprint of food products and related uncertainties
Technology Type(s)	digital curation • statistical analysis
Factor Type(s)	Typologies, sub-tyologies and items of food products
Sample Characteristic - Environment	agroecosystem • food production system
Sample Characteristic - Location	global

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.14115608

Trading water: virtual water flows through interstate cereal trade in India

Cereals are an important component of the Indian diet, providing 47% of the daily dietary energy intake. Dwindling groundwater reserves in India especially in major cereal-growing regions are an increasing challenge to national food supply. An improved understanding of interstate cereal trade can help to identify potential risks to national food security. Here, we quantify the trade between Indian states of five major cereals and the associated trade in virtual (or embedded) water. To do this, we modelled interstate trade of cereals using Indian government data on supply and demand; calculated virtual water use of domestic cereal production using state- and product-specific water footprints and state-level data on irrigation source; and incorporated virtual water used in the production of internationally-imported cereals using country-specific water footprints. We estimate that 40% (94 million tonnes) of total cereal food supply was traded between Indian states in 2011-12, corresponding to a trade of 54.0 km3 of embedded blue water, and 99.4 km3 of embedded green water. Of the cereals traded within India, 41% were produced in states with over-exploited groundwater reserves (defined according to the Central Ground Water Board) and a further 21% in states with critically depleting groundwater reserves. Our analysis indicates a high dependency of Indian cereal consumption on production in states with stressed groundwater reserves. Substantial changes in agricultural practices and land use may be required to secure future production, trade and availability of cereals in India. Diversifying production systems could increase the resilience of India's food system.

Water Resources for Sustainable Healthy Diets: State of the Art and Outlook

Sustainable healthy diets are high on the research and policy agendas. One of the crucial resources to provide such diets are water resources. This paper provides a brief overview of the current research state regarding this topic, with a focus on the water footprint concept, as latter quantifies water use along a supply chain. The water footprint (WF) quantifies blue and green water consumption, as both these water resources are essential for food and energy production as well as for the environment. Different kinds of information are embedded in a dietary WF and different data sources and modelling approaches exist, leading to WF dietary amounts that are not always directly comparable. A full sustainability assessment of a dietary WF encompasses three components: (1) an equity assessment of the total WF amount; (2) an efficiency assessment for each food item in the diet as well as (3) an impact assessment (blue water stress and green water scarcity) for each food item in the diet. The paper concludes with an outlook on future research on the topic, listing the following points: (1) future clarity in system boundary and modelling assumptions, with comparison of results between different approaches; (2) full sustainability assessments including all three components; (3) dietary footprint family assessments with the WF as one member; (4) WF assessments for multiple dietary regimes with support to the development of local dietary guidelines and (5) assessment of the synergies with LCA-based mid-point (scarcity-weighted WF) and end-point (especially human health) indicators and evaluation of the validity and empirical significance of these two indicators

Peak grain forecasts for the US High Plains amid withering waters

Rapid groundwater depletion represents a significant threat to food and water security because groundwater supplies more than 20% of global water use, especially for crop irrigation. A large swath of the US High Plains, which produces more than 50 million tons of grain yearly, depends on the Ogallala aquifer for more than 90% of its irrigation needs. A predator–prey-type model serves as a minimalist representation of groundwater use–crop production dynamics. It explains and predicts reductions in groundwater withdrawal on three High Plains states and subsequent declines in irrigated crop production. The model shows how recharge rates and the adoption of irrigation technologies control these trends. It also provides a general framework for assessing groundwater-based irrigation sustainability.

Irrigated agriculture contributes 40% of total global food production. In the US High Plains, which produces more than 50 million tons per year of grain, as much as 90% of irrigation originates from groundwater resources, including the Ogallala aquifer. In parts of the High Plains, groundwater resources are being depleted so rapidly that they are considered nonrenewable, compromising food security. When groundwater becomes scarce, groundwater withdrawals peak, causing a subsequent peak in crop production. Previous descriptions of finite natural resource depletion have utilized the Hubbert curve. By coupling the dynamics of groundwater pumping, recharge, and crop production, Hubbert-like curves emerge, responding to the linked variations in groundwater pumping and grain production. On a state level, this approach predicted when groundwater withdrawal and grain production peaked and the lag between them. The lags increased with the adoption of efficient irrigation practices and higher recharge rates. Results indicate that, in Texas, withdrawals peaked in 1966, followed by a peak in grain production 9 y later. After better irrigation technologies were adopted, the lag increased to 15 y from 1997 to 2012. In Kansas, where these technologies were employed concurrently with the rise of irrigated grain production, this lag was predicted to be 24 y starting in 1994. In Nebraska, grain production is projected to continue rising through 2050 because of high recharge rates. While Texas and Nebraska had equal irrigated output in 1975, by 2050, it is projected that Nebraska will have almost 10 times the groundwater-based production of Texas.

The Water Footprint of Global Food Production

Agricultural production is the main consumer of water. Future population growth, income growth, and dietary shifts are expected to increase demand for water. The paper presents a brief review of the water footprint of crop production and the sustainability of the blue water footprint. The estimated global consumptive (green plus blue) water footprint ranges from 5938 to 8508 km3/year. The water footprint is projected to increase by as much as 22% due to climate change and land use change by 2090. Approximately 57% of the global blue water footprint is shown to violate the environmental flow requirements. This calls for action to improve the sustainability of water and protect ecosystems that depend on it. Some of the measures include increasing water productivity, setting benchmarks, setting caps on the water footprint per river basin, shifting the diets to food items with low water requirements, and reducing food waste.

Health impacts and environmental footprints of diets that meet the Eatwell Guide recommendations: analyses of multiple UK studies

OBJECTIVES

To assess the health impacts and environmental consequences of adherence to national dietary recommendations (the Eatwell Guide (EWG)) in the UK.

DESIGN AND SETTING

A secondary analysis of multiple observational studies in the UK.

PARTICIPANTS

Adults from the European Prospective Investigation into Cancer - Oxford(EPIC-Oxford), UK Biobank and Million Women Study, and adults and children aged 5 and over from the National Diet and Nutrition Survey (NDNS).Primary and secondary outcome measures risk of total mortality from Cox proportional hazards regression models, total greenhouse gas emissions (GHGe) and blue water footprint (WF) associated with 'very low' (0-2 recommendations), 'low' (3-4 recommendations) or 'intermediate-to-high' (5-9 recommendations) adherence to EWG recommendations.

RESULTS

Less than 0.1% of the NDNS sample adhere to all nine EWG recommendations and 30.6% adhere to at least five recommendations. Compared with 'very low' adherence to EWG recommendations, 'intermediate-to-high adherence' was associated with a reduced risk of mortality (risk ratio (RR): 0.93; 99% CI: 0.90 to 0.97) and -1.6 kg CO2eq/day (95% CI: -1.5 to -1.8), or 30% lower dietary GHGe. Dietary WFs were similar across EWG adherence groups. Of the individual Eatwell guidelines, adherence to the recommendation on fruit and vegetable consumption was associated with the largest reduction in total mortality risk: an RR of 0.90 (99% CI: 0.88 to 0.93). Increased adherence to the recommendation on red and processed meat consumption was associated with the largest decrease in environmental footprints (-1.48 kg CO2eq/day, 95% CI: -1.79 to 1.18 for GHGe and -22.5 L/day, 95% CI: -22.7 to 22.3 for blue WF).

CONCLUSIONS

The health and environmental benefits of greater adherence to EWG recommendations support increased government efforts to encourage improved diets in the UK that are essential for the health of people and the planet in the Anthropocene.

Development of a Danish Adapted Healthy Plant-Based Diet Based on the EAT-Lancet Reference Diet

Plant-based diets have been linked to both health benefits and a lower climate impact. However, plant-based diets may represent both healthy and unhealthy dietary practices. The present study aimed to develop a nationally adapted healthy plant-based diet based on the global EAT-Lancet reference diet. Development took place in a series of steps. First, the original EAT-Lancet reference diet was evaluated based on food availability, i.e., using Danish food data (Model 1). Then, the model was further modified to reflect national food based dietary guidelines (FBDG) and characteristics of current consumption pattern, e.g., by including processed food, discretionary foods and beverages in the diet (Model 2). The contents of macronutrients, vitamins and minerals, except for vitamin D and iodine, were found to be sufficient for Model 2, according to the recommended nutrient density to be used for planning diets for groups of individuals aged 6–65 years. In addition, the study gave an insight into the nutrients and foods to be aware of in planning a predominantly plant-based diet, thereby providing directions for future revisions of sustainable FBDGs. These include a stronger emphasis on the intake of legumes, nuts and seeds, fruit and vegetables including dark green vegetables, whole-grain products and vegetable oils as well as lowering meat intake.

Greenhouse Gas Emissions and Blue Water Use of Dutch Diets and Its Association with Health

Food consumption patterns affect the environment as well as public health, and monitoring is needed. The aim of this study was to evaluate the Dutch food consumption patterns for environmental (greenhouse gas (GHG) emissions and blue water use) and health aspects (Dutch Healthy Diet index 2015), according to age, gender, and consumption moments. Food consumption data for 4313 Dutch participants aged 1 to 79 years were assessed in 2012 to 2016, by two non-consecutive 24-h recalls. The environmental impact of foods was quantified using a life cycle assessment for, e.g., indicators of GHG emissions and blue water use. The healthiness of diet, operationalized by the Dutch Healthy Diet index 2015, was assessed for 2078 adults aged ≥19 years. The average daily diet in the Netherlands was associated with 5.0 ± 2.0 kg CO2-equivalents of GHG emissions and 0.14 ± 0.08 m3 of blue water use. Meat, dairy and non-alcoholic beverages contributed most to GHG emissions, and non-alcoholic beverages, fruits, and meat to blue water use. More healthy diets were associated with a lower GHG emission and higher blue water use. Different associations of environmental indicators (GHG emissions and blue water use) with health aspects of diets need to be considered when aligning diets for health and sustainability.