The importance of food systems and the environment for nutrition

Exploring alternative sources of protein in food: Trends in nutrient and functional features

Proteins are essential biomolecules that perform critical roles in various biological processes, such as building and repairing tissues, transporting substances, signaling hormones, and providing protection. Traditional methods of meeting human protein needs, primarily through animal farming, have significant negative impacts on the environment. In many low-income countries, protein requirements often go unmet due to the high costs associated with animal farming. Additionally, the rise in food allergies has become a serious health concern, highlighting the need for alternative protein sources that cater to individuals sensitive to traditional proteins. As the world's population is projected to reach around nine billion by 2050, there are growing concerns that conventional protein sources may not be sufficient to meet the increasing demand. This situation has led to heightened interest in alternative protein sources that can fulfill nutritional needs without the drawbacks associated with traditional meat consumption. This systematic review aims to explore non-traditional dietary protein sources, focusing on their nutritional and some techno-functional characteristics reported. These sources may include a variety of options such as animals (both vertebrates and invertebrates), plants (like leaves, seeds, and legumes), algae, fungi, and by-products from the food industry.

Associations between national plant-based vs animal-based protein supplies and age-specific mortality in human populations

Transitions to sustainable food systems require shifts in food production and availability, particularly the replacement of animal-based protein with plant-based protein. To explore how this transition may relate to demographic patterns, we undertake an ecological analysis of global associations between age-specific mortality, total national macronutrient distributions, and protein substitution. Our dataset includes per capita daily food supply and demographic data for 101 countries from 1961-2018. After adjusting for time, population size, and economic factors, we find associations between low total protein supplies and higher mortality rates across all age groups. Early-life survivorship improves with higher animal-based protein and fat supplies, while later-life survival improves with increased plant-based protein and lower fat supplies. Here, we show that the optimal balance of protein and fat in national food supplies, which correlates with minimal mortality, varies with age, suggesting that reductions in dietary protein, especially from animal sources, may need to be managed with age-specific redistributions to balance health and environmental benefits.

Planetary health diet, mediterranean diet and micronutrient intake adequacy in the Seguimiento Universidad de Navarra (SUN) cohort

PURPOSE

Our study aimed to investigate and compare the association between adherence to a priori Planetary Health Diet Index and two well-known Mediterranean indices, the Mediterranean Diet Score (MDS) and the Mediterranean Adherence Screener (MEDAS), and micronutrient intake adequacy.

METHODS

We assessed 18,259 Spanish university graduates at baseline who participated in the SUN cohort using a validated semi-quantitative food frequency questionnaire. Inadequate intake of Zn, I, Se, Fe, Ca, P, Mg, Cr, K, vitamins B1, B2, B3, B6, B12, C, A, D, E, and folic acid was evaluated using the estimated average requirement (EAR) cut-point approach and the probabilistic approach. Logistic regression analyses were conducted to estimate the probability of failing to meet EAR for either ≥ 3 or ≥ 6 micronutrients.

RESULTS

Participants with higher adherence to the Planetary Health Diet had a lower risk of overall inadequacy, while the Mediterranean Diet (MedDiet) showed even greater nutritional adequacy. The adjusted Odds Ratio (OR) for failing to meet ≥ 3 EAR was 0·24 (95% CI 0·21 - 0·27) for the Planetary Health Diet Index, whereas it was substantially lower for MEDAS with OR = 0·12, 95% CI 0·11 - 0·13, and for MDS with OR = 0·09, 95% CI 0·08 - 0·10, always for the comparison of the fourth v. first quartile and using the probabilistic approach method.

CONCLUSION

In this Mediterranean cohort, better adherence to both the Planetary Health Diet and the MedDiet (with a stronger inverse association) showed lower risk of micronutrient inadequacy.

Importance of yam in the role of agrobiodiversity in Mayombe and Batéké Plateau ecozones in Democratic Republic of Congo

The Mayombe and Batéké Plateau ecozones of the Democratic Republic of Congo (DRC) are experiencing differentiated deforestation and forest degradation, together with a trend toward homogenization of their agricultural diversity. These may undermine efforts to sustainably reverse household food, nutrition, and livelihood insecurity. In this context, this study seeks to assess the importance of yam in the role of agrobiodiversity among populations in the two contrasting ecozones. A sample of 351 households was surveyed. A dataset of about 202 testimonies from six focus groups and observations in 86 peasant agroforestry fields was also analyzed using descriptive statistics, correlation and regression, and calculations of different indices of crop importance. Overall, plant, animal, and fish species represent respectively 60.9%, 26.7% and 12.4% of genetic resources. About 50 of 72 species of these resources are found in both study areas. Regarding the overall use of species, the five top-ranked species that were utilized as food included Manihot esculenta, followed by Arachis hypogaea, Zea mays, Dioscorea alata, and Musa acuminata. Living in the Mayombe ecozone increases the household's preference for growing yams by up to 5.7 times. Population density was correlated with agricultural diversity. Villages with a high population density showed greater crop diversity than those with a low population density. In short, yam remains an important but under-represented crop, the contribution of which could be increased to secure sustainable livelihoods through biodiversity-rich peasant agroforestry systems.

The Two Dimensions of Nutrition for the Planet: Environment and Health

PURPOSE OF REVIEW

Protecting the planet is protecting the future. Food production systems are among the most important human activities threatening planetary health. Diet, food systems, the environment, and health are interconnected. Accordingly, this review aims to assess the effects of nutrition on the planet and the relationship between some types of diets defined as sustainable and the planet and human health.

RECENT FINDINGS

Many diets have been proposed to protect the planet and human health, but there is no consensus on which diet is best. It should not be forgotten that planetary health diets, plant-based diets, and vegetarian/vegan diets can reduce environmental pressure. Still, they cannot have the same effect in every country, and these diets may have different effects depending on the differences in the countries' income level, nutritional culture, and food systems. Moreover, it should not be overlooked that these diets may cause difficulties in terms of adaptation, cause deficiencies in some nutrients, and may not be suitable for all segments of society. Sustainable diets such as the Mediterranean and New Nordic, as well as Dietary Approaches to Stop Hypertension, are more flexible and acceptable. Instead of a globally recommended reference diet to protect the planet and human health, each country can analyze its food systems and choose the most appropriate food production methods and sustainable diet style to reduce environmental burden, improve health, and create policies accordingly, which can help achieve sustainable goals faster.

MUSAE: Fusion of art and technology to address challenges in food and health

There is an urgent need to transform our current food system to improve population health/wellbeing and planetary health. A number of challenges exist in order to achieve this. Artists, with their innate ability to use imagination to envision future needs and solve problems, represent a key group in this transformation. The project MUSAE brings together artists with experts from different disciplines to define an innovative model to integrate artistic collaboration in the (European) Digital innovation hubs (E-DIHs). They will employ the Design Futures Art-Driven (DFA) methods to enable artists and a range of companies involved in food production and distribution to develop innovative products and services that address key issues in the food system. MUSAE will run two residencies involving 23 artists and 11 SMEs working with three main technologies-Artificial Intelligence, Wearables and Robotics-to envision the future scenarios for societal needs and technology applications, as well as develop future-driven prototypes, thus opening new markets and innovations in the area of food.

The portrayal of panic-buying and stockpiling in English newspapers during Covid, a mixed-method content analysis

Panic-buying and stockpiling during Covid disrupted the supply chain, causing food shortages and impacting the vulnerable. The government faced criticism for its lack of food system resilience, poor communications planning, and reliance on retailers. The British media frequently reported on panic-buying during early lockdown stages in 2020 and throughout Covid. The media play an important role in communicating information to the British public during times of crisis and influence public opinion. This mixed-method study examined English media portrayal of panic-buying, analysing text and visual data from six of the highest-circulating newspapers from March to July 2020. It reviewed reporting trends, use of imagery, themes, and prominent stakeholder voices. Content analysis of 209 articles showed that coverage was dominated by popular and left-wing press, with 89% of articles using sensationalised language and 68% coded as negative. In a subset of 125 articles, visual imagery showed empty shelves in 64% of analysed images, reinforcing the impression of food shortages. Supermarkets were the most quoted stakeholders, appearing in 62% of articles. Contradictions included reports of no food shortages alongside images of empty shelves and early newspaper advice encouraging stockpiling. Reporting peaked between March 16-22, 2020. Six key themes were identified: supermarket prominence, food supply/access, food policy, individual behaviour, socio-economic impacts, and panic-buying drivers-all themes had relevance to food system resilience. Future civil unrest linked to food-system challenges, potentially driven by climate change, conflict, or political instability, could see panic-buying play a significant role. Research on media portrayals of panic-buying can help policymakers enhance communication strategies and identify critical issues during crises. The Covid pandemic revealed crucial lessons about the media's potential role in shaping public behaviour, highlighting the need for stronger government communication and collaboration with both the media and retailers to ensure consistent messaging, particularly to protect vulnerable groups.

A comparison of development methods used to define portion sizes in food-based dietary guidelines around the world

Introduction

Food-based dietary guidelines (FBDGs) are essential public health tools for delivering dietary recommendations, and generally include guidance on portion sizes. Despite existing guidelines on developing and implementing FBDGs, there is still no consensus on best practices for their formulation. This paper compares the methodologies used by public health organizations to create FBDGs and examines how both methodology and geographical location may influence recommended portion sizes.

Methods

Documents on FBDG development were obtained from the Food and Agriculture Organization online repository of FBDGs, either directly from consumer-facing FBDG or from corresponding scientific reports. Methodological details in FBDG development were extracted and categorized. Recommended portions in grams per day were extracted for 15 food categories to enable comparison across development methods and global regions.

Results

FBDGs from 96 countries were accessed and translated. Of these, n = 83 were based on consensus/review, n = 15 used data-based approaches, and n = 30 included other minor calculations. Thirty-nine FBDGs were derived from a combination of consensus/review and another method. Of the countries providing portion size information, only one did not report its methodological approach. Comparisons of median portions sizes of food groups across methodologies showed no significant differences. Analyses across regions revealed that portion recommendations were generally consistent, with significant differences found only for one food group, namely, Fish & shellfish, where portion size recommendations were significantly higher in Europe compared to those in Latin America and the Caribbean.

Discussion

Results indicate little variation in the recommendations for portion size across development methods, and for most food groups, across global regions. These findings suggest there is potential to harmonize portion size derivation in FBDGs at regional or global levels. However, further research is needed to assess whether harmonized guidance can apply to other aspects of FBDGs.

Centering the body in agricultural development: Bridging conceptualizations of bodies-as-mechanism and bodies-as-affective

There is resurgent interest in making agriculture more "nutrition sensitive" to address longstanding rural health disparities. Yet, the relations between agri-ecological systems and producer wellbeing and health are complex, and approaches to studying them are scattered across multiple disciplinary traditions. This paper forges a methodological framework to study how bodily and social wellbeing may be facilitated/hindered amongst individuals engaged in agriculture by centering the material body within agriculture-nutrition analyses. Our framework integrates approaches that view bodies in mechanistic terms - using energy balance models, time-use data and diet diversity metrics - alongside those that view bodies in material and relational dimensions where affects, emotions, sensations, and discourse are important "variables'' imbricated in producer health and wellbeing. We use this framework to examine qualitative data from diverse sites in the United States heartland and central India. Our analysis highlights the contradictions that emerge when desires for chemical-free, diversified foods intersect with lived realities of laboring for such food, particularly within contexts riddled with inequity across multiple scales. We find that while mechanistic approaches collect important quantitative data about bodies as laborers and consumers, the everyday acts of laboring and feeding (others and self) are steeped in social meaning and sensorial richness that have strong effects on wellbeing. We conclude by reflecting on the lack of "win-win" solutions in making smallholder food systems more conducive to nutritional wellbeing, and instead outline important trade-offs that emerge and offer suggestions for potential policy solutions.

Calorie (energy) labelling for changing selection and consumption of food or alcohol

BACKGROUND

Overconsumption of food and consumption of any amount of alcohol increases the risk of non-communicable diseases. Calorie (energy) labelling is advocated as a means to reduce energy intake from food and alcoholic drinks. However, there is continued uncertainty about these potential impacts, with a 2018 Cochrane review identifying only a small body of low-certainty evidence. This review updates and extends the 2018 Cochrane review to provide a timely reassessment of evidence for the effects of calorie labelling on people's selection and consumption of food or alcoholic drinks.

OBJECTIVES

- To estimate the effect of calorie labelling for food (including non-alcoholic drinks) and alcoholic drinks on selection (with or without purchasing) and consumption. - To assess possible modifiers - label type, setting, and socioeconomic status - of the effect of calorie labelling on selection (with or without purchasing) and consumption of food and alcohol.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, five other published or grey literature databases, trial registries, and key websites, followed by backwards and forwards citation searches. Using a semi-automated workflow, we searched for and selected records and corresponding reports of eligible studies, with these searches current to 2 August 2021. Updated searches were conducted in September 2023 but their results are not fully integrated into this version of the review.

SELECTION CRITERIA

Eligible studies were randomised controlled trials (RCTs) or quasi-RCTs with between-subjects (parallel group) or within-subjects (cross-over) designs, interrupted time series studies, or controlled before-after studies comparing calorie labelling with no calorie labelling, applied to food (including non-alcoholic drinks) or alcoholic drinks. Eligible studies also needed to objectively measure participants' selection (with or without purchasing) or consumption, in real-world, naturalistic laboratory, or laboratory settings.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion and extracted study data. We applied the Cochrane RoB 2 tool and ROBINS-I to assess risk of bias in included studies. Where possible, we used (random-effects) meta-analyses to estimate summary effect sizes as standardised mean differences (SMDs) with 95% confidence intervals (CIs), and subgroup analyses to investigate potential effect modifiers, including study, intervention, and participant characteristics. We synthesised data from other studies in a narrative summary. We rated the certainty of evidence using GRADE.

MAIN RESULTS

We included 25 studies (23 food, 2 alcohol and food), comprising 18 RCTs, one quasi-RCT, two interrupted time series studies, and four controlled before-after studies. Most studies were conducted in real-world field settings (16/25, with 13 of these in restaurants or cafeterias and three in supermarkets); six studies were conducted in naturalistic laboratories that attempted to mimic a real-world setting; and three studies were conducted in laboratory settings. Most studies assessed the impact of calorie labelling on menus or menu boards (18/25); six studies assessed the impact of calorie labelling directly on, or placed adjacent to, products or their packaging; and one study assessed labels on both menus and on product packaging. The most frequently assessed labelling type was simple calorie labelling (20/25), with other studies assessing calorie labelling with information about at least one other nutrient, or calories with physical activity calorie equivalent (PACE) labelling (or both). Twenty-four studies were conducted in high-income countries, with 15 in the USA, six in the UK, one in Ireland, one in France, and one in Canada. Most studies (18/25) were conducted in high socioeconomic status populations, while six studies included both low and high socioeconomic groups, and one study included only participants from low socioeconomic groups. Twenty-four studies included a measure of selection of food (with or without purchasing), most of which measured selection with purchasing (17/24), and eight studies included a measure of consumption of food. Calorie labelling of food led to a small reduction in energy selected (SMD -0.06, 95% CI -0.08 to -0.03; 16 randomised studies, 19 comparisons, 9850 participants; high-certainty evidence), with near-identical effects when including only studies at low risk of bias, and when including only studies of selection with purchasing. There may be a larger reduction in consumption (SMD -0.19, 95% CI -0.33 to -0.05; 8 randomised studies, 10 comparisons, 2134 participants; low-certainty evidence). These effect sizes suggest that, for an average meal of 600 kcal, adults exposed to calorie labelling would select 11 kcal less (equivalent to a 1.8% reduction), and consume 35 kcal less (equivalent to a 5.9% reduction). The direction of effect observed in the six non-randomised studies was broadly consistent with that observed in the 16 randomised studies. Only two studies focused on alcoholic drinks, and these studies also included a measure of selection of food (including non-alcoholic drinks). Their results were inconclusive, with inconsistent effects and wide 95% CIs encompassing both harm and benefit, and the evidence was of very low certainty.

AUTHORS' CONCLUSIONS

Current evidence suggests that calorie labelling of food (including non-alcoholic drinks) on menus, products, and packaging leads to small reductions in energy selected and purchased, with potentially meaningful impacts on population health when applied at scale. The evidence assessing the impact of calorie labelling of food on consumption suggests a similar effect to that observed for selection and purchasing, although there is less evidence and it is of lower certainty. There is insufficient evidence to estimate the effect of calorie labelling of alcoholic drinks, and more high-quality studies are needed. Further research is needed to assess potential moderators of the intervention effect observed for food, particularly socioeconomic status. Wider potential effects of implementation that are not assessed by this review also merit further examination, including systemic impacts of calorie labelling on industry actions, and potential individual harms and benefits.

Mapping the Drivers of Multisectoral Nutrition Governance and Its Link to Nutrition Outcomes in Kenya: A Qualitative Inquiry

BACKGROUND

Malnutrition remains a significant public health issue in Kenya. Multisectoral Nutrition Governance (MNG) is increasingly being acknowledged as a catalyst for enhancing nutrition programming and outcomes. Effective MNG establishes policies, systems, and mechanisms that enable coordinated, adequately funded, and sustainable nutrition actions across sectors; however, its understanding and progress assessment remain inadequate.

OBJECTIVE

This study aimed to qualitatively assess the status of MNG and propose strategies to strengthen MNG mechanisms for improved nutrition actions and outcomes in Kenya. We hypothesized that effective performance across the MNG domains is associated with effective multisectoral nutrition actions and improved nutrition outcomes.

DESIGN

This study used a qualitative design to assess the MNG status over the past 10 years (2012-2023). Nineteen program managers and officers from government and non-governmental institutions implementing nutrition at the national level were included. Data collection was conducted between January and March 2024 through key informant interviews (KIIs). Thematic analysis, guided by both inductive and deductive coding, was carried out using MAXQDA (Maximizing Qualitative Data Analysis) software.

RESULTS

The findings indicate progress in strengthening MNG in the previous decade, though gaps persist. The progress was driven by improved political awareness and commitment, the adoption of nutrition policy and planning frameworks, and improved coordination. Constraints that impede MNG progress include inadequate financing and over-reliance on donor funding, limited translation of commitments to actions, lack of unified monitoring and evaluation (M&E) systems and fragmented policies.

CONCLUSIONS

Strengthening multisectoral M&E systems that allow timely collection and utilization of data, ensuring sustainable financing for nutrition, enhancing accountability mechanisms and improving coherence across sectors are important for further improvement of MNG.

Old Plants for New Food Products? The Diachronic Human Ecology of Wild Herbs in the Western Alps

This ethnobotanical study examines the traditional knowledge and usage patterns of wild plants in the western Alps, specifically within the Ubaye and Bellino Valleys, through a comparative analysis of data collected from 1983 (published in 1990) to 2024. Our study aims to assess the change in plant usage, species diversity, and the changing roles of plants in local traditions in the western Alpine mountain ecosystems. While the 1983 survey documented medicinal uses centered around pastoralist practices, the 2024 data highlight a notable increase in the use of synanthropic plants, now utilized both medicinally and as food. Several species such as Allium sativum, Artemisia absinthium, and Urtica dioica have shown resilience and continuity in local cultural practices, maintaining medicinal, culinary, and ritual significance across the four decades. The 1983 survey documented the greatest variety of species (101), a number that decreased in subsequent studies. The 2009 survey identified 36 species not previously recorded in 1983, and the 2024 field study noted an additional 20 species. The study highlights the economic potential of several wild species in these alpine areas, such as Achillea, Artemisia, Verbascum, Veronica, Viola, Polygonum, Bunium, and Sorbus spp., which could be utilized for creating new herbal teas, artisanal beers, liqueurs, ice creams, sweets, and seasoned food products. Expanding the uses of these plants could not only preserve ethnobotanical knowledge but also stimulate local economies and support sustainable development in alpine communities. The documented temporal shifts in plant usage reflect broader cultural, ecological, and socio-economic changes, underscoring the importance of preserving biodiversity and traditional knowledge amidst ongoing environmental and societal shifts. This study underlines the need to conserve ethnobotanical heritage while adapting to the evolving landscape of the region. Future research could focus on exploring the role of these species in broader sustainability initiatives, including conservation strategies, ecosystem services, and community-based tourism while continuing to document the cultural dynamics influencing plant usage.

Dietary protein considerations in a sustainable and ageing world: a narrative review with a focus on greenhouse gas emissions and skeletal muscle remodelling and maintenance

The rise in interest of plant-based protein foods has been meteoric, often leading to calls to adopt exclusively plant-based diets to reduce the intake of animal-based foods. In addition to impacts on human health, moving to an exclusively plant-based (or indeed animal-based) diet may have detrimental implications in terms of environmental sustainability. The impact of a rapid growth in global population on the sustainability of food systems poses clear consequences for the environment and thus warrants careful consideration at a national and, in some cases, global level. The requirement for high-quality dietary protein in an ageing population to offset chronic disease, such as sarcopenia, is an additional consideration. A reductionist approach to this sustainability issue is to advise a global population switch to plant-based diets. From a dietary protein perspective, the sustainability of different non-animal-derived protein sources is a complex issue. In this review, first we describe the role of dietary protein in combatting the age-related decline in skeletal muscle mass. Next, we explore the efficacy and sustainability of protein sources beyond animal-based proteins to facilitate skeletal muscle remodelling in older age. Taking a holistic approach, we discuss protein sources in terms of the muscle anabolic potential, environmental considerations with a predominant focus on greenhouse gas emissions across the food chain, the relevance of global malnutrition, and nation- and local-specific nutritional needs for dietary protein choices and food systems. Finally, we discuss implications for environmental sustainability and explore the potential of a trade-off between diet quality and environmental sustainability with food choices and recommendations.

Urine Metabolomics during a Legume Diet Intervention Suggests Altered Metabolic Signatures and Potential New Intake Markers: First Insights

Given the general increase in legume consumption worldwide, there is a need to characterize the resulting human metabolic adaptations in order to demonstrate potential legume diet/health relationships. A nuclear magnetic resonance (NMR) metabolomics urine study was carried out on a small cohort (n = 18) to characterize the excretory effects of a pilot longitudinal 8-week legume-based dietary intervention. Despite the expected high interindividual variability in the excreted metabolome, the results suggested a nonlinear metabolic response, with higher metabolic activity in the first 4 weeks and a tendency toward baseline at the end of the intervention. The excretion of isoleucine, leucine, and threonine increased, along with metabolite changes suggestive of activation of the tricarboxylic acid cycle (through anaplerosis), ketogenesis, fat catabolism, and glycoprotein biosynthesis. Gut microbiota adaptations were also suggested based on the increased excretion of 2-hydroxyisobutyrate, allantoin, and hippurate. Increased levels of trigonelline were consistent with its role as a legume intake marker, whereas malonate and pseudouridine were suggested as possible additional markers. Correlation of NMR data with nutritional parameters aided putative explanatory hypotheses to be advanced. Our results suggest a dynamic response to legume consumption, mainly through increased amino acid excretion and altered energy metabolism, while advancing potential new markers of legume intake. These results require confirmation in larger cohorts but pave the way for an informed interpretation of the effects of legume-based diets on human health.

Perceptions and preferences for environmentally sustainable food and associated factors: a cross-sectional analysis of a nationally representative survey of United States consumers

BACKGROUND

Consumers are increasingly interested in environmentally sustainable dietary patterns. However, specific signals (e.g., language, labels, logos, or packaging) American consumers use to identify environmentally sustainable products are yet to be explored.

OBJECTIVES

To determine perception and preferences for environmentally sustainable food and associated health and demographic factors associated with consumers' use of signals for environmentally sustainable food products in a nationally representative survey of United States consumers.

METHODS

Repeated cross-sectional data were collected for the 2019 and 2020 annual online Food and Health Survey by the International Food Information Council. Three questions were analyzed: 1) the stated importance of environmentally sustainable food products, 2) signals consumers use to identify environmentally sustainable food/beverage products, and 3) the impact of environmental sustainability on food/beverage purchase decisions. Questions 2 and 3 were asked only from participants who stated environmental sustainability is important in question 1. Options provided for signals for environmentally sustainable products were recyclable packaging, minimal packaging, labeled organic, labeled locally grown, labeled sustainably sourced, and labeled non-genetically modified organisms (GMOs)/not bioengineered. Poisson regression and logistic regressions were performed to assess associations.

RESULTS

Of 1905 completers, 1059 (55.6%) answered that it was somewhat or very important that food products purchased/consumed were environmentally sustainable. Of those, 94% used ≥1 of the 6 signals to determine environmental sustainability when shopping. Some signals were selected despite little association with environmental sustainability (e.g., locally grown and non-GMO/not bioengineered). The number of signals consumers used was associated with education, race/ethnicity, health status, and the level of impact they reported that sustainability plays in their decisions. Associations between consumer characteristics and the use of different signals for environmental sustainability were heterogeneous.

CONCLUSIONS

Even among consumers who value environmental sustainability in food products, specific signals used by different respondents varied across demographics and health characteristics.

Positive impact of nutrition in the prevention of peripheral vascular disease and severe acute respiratory syndrome coronavirus 2: review

Recent research has shown that there is a link between the trend of cardiovascular disease (CVD), chronic symptoms of SARS-CoV-2 (COVID-19), and medical nutrition therapy. Making positive changes to an individual's lifestyle can help to reduce the symptoms that follow exposure to CVD and COVID-19. Sustainable nutrition and lifestyle changes can positively impact an individual's health. Studies have considered the risk factors associated with the disease, medical history, the link between nutrition and peripheral vascular disease (PVD), symptom management, and the interrelationship between nutrition, COVID-19, and PVD. One study has demonstrated that Western Dietary intake can boost the innate immune system while suppressing humoral response, causing chronic inflammation and poor host defense against viruses. However, further investigation is needed to confirm. Patients with PVD and COVID-19 have experienced a reduction in side effects when prescribed a regimen of medical nutrition therapy, heart-healthy diets, and adequate physical activity before and after symptoms of both diseases appear. This approach has proven to be a protective factor during the combination of both illnesses. Our findings indicate that balanced diet and lifestyle are essential in supporting an optimal immune system that can reduce the risk of virus load in individuals at risk of infection and symptoms from COVID-19 and PVD.

Rethinking the Social Determination of Food in Chile Through Practices and Interactions of Actors in Food Environments: Nonexperimental, Cross-Sectional Study

BACKGROUND

Food environments are crucial for promoting healthy and sustainable eating and preventing obesity. However, existing food environment frameworks assume an already installed causality and do not explain how associations in food environments are established or articulated, especially from an integrative and transdisciplinary approach. This research attempts to bridge these gaps through the use of Actor-Network Theory, which traces the relationship network between human (and nonhuman) actors in order to describe how these interact and what agencies (direct or remote) are involved.

OBJECTIVE

This study aims to explain the practices and interactions of actors in food environments in order to approach the problem of unhealthy eating with a transdisciplinary approach.

METHODS

This is a nonexperimental, cross-sectional study. Due to the complexity of the study phenomena, a mixed methods approach with 4 consecutive phases will be developed in Chile. Phase 1 involves a systematic literature review of food environment evidence since 2015, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol; phase 2 involves the application of a shortened version of the Nutrition Environment Measure Scale-Perceptions adapted to Chile (NEMS-P-Ch) in 2 neighborhoods with different socioeconomic levels; in phase 3, six focus groups in each neighborhood will be conducted to address social determinants such as gender, employment status, and migration; and in phase 4, participant observation and in-depth interviews will be used to analyze the direct and empirical exploration of the actors in their daily interaction with food environments. The triangulation and complementarity of the data will allow us to create a practical model about the practices and interactions of actors in their food environments, which reflects the complexity and transdisciplinary nature of the study.

RESULTS

We have advanced in phases 1-3 of the study. In phase 1, a total of 109 manuscripts are being revised for data extraction. In phase 2, we applied the NEMS-P-Ch to 785 people, 49.4% (388/785) of whom belong to a low socioeconomic neighborhood. Participants from phase 2 are being contacted to participate in the focus groups (phase 3). By the end of July, we have conducted 6 focus groups with 5-11 participants.

CONCLUSIONS

This study will provide a comprehensive understanding of how individuals interact with their food environments, offering deep insights into the factors influencing their food-related decisions. In addition, the study aims to develop a model that more accurately reflects reality by examining not only the food environments themselves but also the interactions among various stakeholders within these environments and their daily practices. The findings of this study will offer evidence-based insights to inform public policies tailored to the specific territories and communities under investigation or those with similar characteristics.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/62765.

Environmental Sustainability of Food Environments: Development and Application of a Framework in 4 cities in South Asia

Background

Food environments, where people directly engage with broader food systems, may be an important contributor to the environmental sustainability of food systems.

Objectives

The primary objectives of this study were to establish a new food environment framework that considers environmental indicators and to assess data availability and gaps using data previously collected as part of a food systems survey in 4 South Asian cities.

Methods

The framework was developed by conducting a structured literature review of previous food environment frameworks and in-depth interviews with content experts (n = 6). The framework and indicators were then mapped to data collected by consumer and vendor surveys using the Urban Food Systems Assessment Tool (UFSAT) in Ahmedabad (India), Pune (India), Kathmandu (Nepal), and Pokhara (Nepal).

Results

We have expanded the sustainability domain within food environments to include consumer travel to food vendors, the presence of food delivery services, policies related to sustainability, vendor food waste, vendor plastic use, vendor utility usage, vendor recycling and waste management practices, and food packaging. Mapping the framework to existing data from 4 cities in South Asia, we found variations in food environment sustainability indicators, particularly regarding consumer transportation to food vendors, the presence of delivery services, and food waste.

Conclusions

Although the majority of food environment research focuses on the availability and affordability of healthy foods, there is an urgent need to understand better how aspects of food environments contribute to environmental goals. When mapping the framework to existing food systems data, we found gaps in data on environmental sustainability in food environments and variation in indicators across settings.

The role of corruption in global food systems: a systematic scoping review

BACKGROUND

Corruption exists at all levels of our global society and is a potential threat to food security, food safety, equity, and social justice. However, there is a knowledge gap in the role and impact of corruption within the context of the global food system. We aimed to systematically review empirical literature focused on corruption in the global food system to examine how it is characterized, the actors involved, its potential impacts, and the solutions that have been proposed to address corruption in the food system.

METHODS

We used a systematic scoping review methodology. Terms combining corruption and the food system were searched in Scopus, PubMed, Web of Science, PsycInfo and Econlit, in October 2021. Two screeners applied a priori selection criteria to screen the articles at the title and abstract and full-text levels. Data was extracted into a charting form and thematically synthesized to describe the types of corruption in the food system, the actors involved, how corruption impacts the food system, and potential solutions. Sankey diagrams and narrative summaries were developed to summarize the included studies and findings.

RESULTS

From the 238 included records, five main types of corruption were identified in the global food system: bureaucratic corruption, fraud, bribery, organized crime, and corporate political activity. These different types of corruption spanned across various food system areas, from policy and governance structures to food environments, and involved a wide range of actors. More powerful actors like those in public and private sectors tended to instigate corruption in the food system, while community members and primary producers tended to be impacted by it. The impacts of corruption were mostly negative and corruption was found to undermine food system governance and regulatory structures; threaten health, safety, and food security; and lead or contribute to environmental degradation, economic loss, erosion of trust, social inequities, and decreased agricultural productivity. While solution-oriented literature was limited, the essential role of strong governance,  use of technology and predictive modelling methods to improve detection of corruption, and organizational approaches to problem solving were identified.

CONCLUSION

Our review findings provide researchers and policymakers with a comprehensive overview of corruption in the global food system, providing insights to inform a more holistic approach to addressing the issue. Addressing corruption in the food system is an essential element of supporting the transition to a more healthy, equitable and sustainable global food system.

Food Choices, Sustainability and Australian Native Foods: Perceptions among University Students

(1) Background: Urgent changes in our food choices are needed for more sustainable, resilient and equitable food systems. Australian native plant-based foods have both environmental and health benefits. Including these foods in our diet may reduce both the risk of chronic diseases and the impact of climate change. This study explored the perceptions and attitudes towards food choices, sustainability and Australian native plant-based food among university students. (2) Methods: A cross-sectional online survey was completed by 212 university students in Australia from October to December 2022. Questions included information about sociodemographic characteristics, food choices, Australian native foods and the impact on sustainability. Logistic regression was used for analyses. (3) Results: Most participants recognised the impact of food choices on sustainability. There was a significant association between recognition of the impact of food choices on sustainability and the environmental and nutritional benefits of Australian native foods (OR = 2.89, 95% CI 1.29, 6.46, p = 0.010). Students who were familiar with or had tried Australian native plant-based foods were significantly more likely to recognise their environmental and nutritional benefits (p < 0.001). (4) Conclusions: Students who recognise the impact of food choices on sustainability and the benefits of Australian native foods are more likely to include native foods in their diet. More studies are needed to investigate the specific native foods consumed and the barriers and facilitators to the intake of these foods.

Predicting the short and long term effects of food price inflation, armed conflicts, and climate variability on global acute malnutrition in Somalia

BACKGROUND

Malnutrition poses a substantial challenge in Somalia, impacting approximately 1.8 million children. This critical issue is exacerbated by a multifaceted interplay of factors. Consequently, this study seeks to examine the long-term and short-term effects of armed conflicts, food price inflation, and climate variability on global acute malnutrition in Somalia.

METHODS

The study utilized secondary data spanning from January 2015 to December 2022, sourced from relevant databases. Two distinct analytical approaches were employed to comprehensively investigate the dynamics of global acute malnutrition in Somalia. Firstly, dynamic autoregressive distributed lag (ARDL) simulations were applied, allowing for a nuanced understanding of the short and long-term effects of armed conflicts, food price inflation, and climate variability on malnutrition. Additionally, the study employed kernel-based regularized least squares, a sophisticated statistical technique, to further enhance the robustness of the findings. The analysis was conducted using STATA version 17.

RESULTS

In the short run, armed conflicts and food price inflation exhibit positive associations with global acute malnutrition, particularly in conflict-prone areas and during inflationary periods. Moreover, climatic variables, specifically temperature and rainfall, demonstrate positive associations. It is important to note that temperature lacks a statistically significant relationship with global acute malnutrition in the short run. In the long run, armed conflicts and food price inflation maintain persistent impacts on global acute malnutrition, as confirmed by the dynamic ARDL simulations model. Furthermore, both temperature and rainfall continue to show positive associations with global acute malnutrition, but it is worth noting that temperature still exhibits a non-significant relationship. The results from kernel-based regularized least squares were consistent, further enhancing the robustness of the findings.

CONCLUSIONS

Increased armed conflicts, food price inflation, temperature, and rainfall were associated with increased global acute malnutrition. Strategies such as stabilizing conflict-prone regions, diplomatic interventions, and peace-building initiatives are crucial, along with measures to control food price inflation. Implementing climate adaptation strategies is vital to counter temperature changes and fluctuating rainfall patterns, emphasizing the need for resilience-building. Policymakers and humanitarian organizations can leverage these insights to design targeted interventions, focusing on conflict resolution, food security, and climate resilience to enhance Somalia's overall nutritional well-being.

Environmental-, Climate-, and Health-Related Dietary Motivations Are Associated With Higher Diet Quality in a National Sample of US Adults With Lower Incomes

BACKGROUND

Plant-based diets can have co-benefits for human and planetary health. Associations between environmental, climate, and health concerns and dietary intake in US adults are understudied, particularly in underserved populations.

OBJECTIVE

The study objectives were to assess how dietary choices motivated by the environment, climate, and health vary by sociodemographic characteristics and how they relate to diet quality and intake frequency of different food groups in US adults with lower incomes.

DESIGN

The study design was cross-sectional.

PARTICIPANTS/SETTING

A web-based survey was fielded in December 2022 to 1,798 US adults with lower incomes (<250% of federal poverty guidelines).

MAIN OUTCOME MEASURES

Environmental-, climate-, and health-related dietary motivations and diet quality and dietary food group intake frequency were assessed.

STATISTICAL ANALYSES

Differences in mean dietary outcomes and dietary motivation ratings by sociodemographic characteristics were evaluated using analysis of variance and Kruskal-Wallis tests. Associations between dietary motivations and diet quality scores and dietary intake frequency were examined using generalized linear models adjusted for sociodemographic covariates.

RESULTS

Younger adults, women, nonbinary people, racial and ethnic minoritized groups, and adults experiencing food insecurity reported higher environmental and climate dietary motivations; older adults, higher-income adults, and food-secure adults reported higher health motivations. Agreeing with environmental- (β = 2.28, 95% CI 1.09 to 3.47), climate- (β = 2.15, 95% CI 0.90 to 3.40), and health-related (β = 5.27, 95% CI 3.98 to 6.56) dietary motivations was associated with higher diet quality scores compared with those with neutral rankings. Similarly, agreement with environmental-, climate-, and health-related dietary motivations was associated with higher intake frequency of fish, fruits and vegetables, and plant proteins, but not with red and processed meat intake frequency. Of several climate-mitigation behaviors presented, participants perceived meat reduction as least effective (P < .001).

CONCLUSIONS

Environment, climate, and health were positive motivators of several healthy dietary choices in US adults with lower incomes. Such motivators did not translate to lower intake frequency of red and processed meat.

The dynamics in food selection stemming from price awareness and perceived income adequacy: a cross-sectional study using 1-year loyalty card data

BACKGROUND

Higher cost of healthy foods may explain unhealthy dietary patterns in lower-income households. Unfortunately, combining food selection and nutrient intake data to price and expenditure is challenging. Food retailer's customer loyalty card data, linked to nutrient composition database, is a novel method for simultaneous exploration of food purchases, price, and nutrition.

OBJECTIVES

We studied the associations between perceived income adequacy (PIA) as a grouping variable with price (per kilogram or megajoule) and the volume of purchases (percentage of expenditure or energy) simultaneously as outcome variables for 17 most purchased food groups.

METHODS

We used 1-year (2018) loyalty card data from the largest grocery chain in Finland. Participants were 28,783 loyalty cardholders who made ≥41% of food purchases from the retailer and answered an online questionnaire at the midpoint of data collection. The 5-level PIA described the perceived financial situation in the household. Energy and nutrient content of foods purchased were from the Finnish Food Composition Database Fineli. We calculated the Nutrient Rich Food Index per 100 g food using 11 nutrients. Trends in prices and expenditures between PIA levels were analyzed using 2-sided Jonckheere-Terpstra tests, with false discovery rate control (Benjamini-Hochberg method) and confounder adjustments (inverse probability weighting).

RESULTS

Lower PIA participants selected cheaper foods per kilogram and megajoule within most food groups. They also favored unhealthy food groups cheap in energy [<1 € (USD 1.18)/MJ]. Despite lower purchase price, the expenditure (%) among lower PIA was higher on alcohol, snacks, sugar-sweetened beverages, and sweets and chocolates.

CONCLUSIONS

Participants with lower PIA showed stronger price awareness. It is crucial to consider the pricing of competing alternative food groups, when steering toward environmentally sustainable and healthier food purchases. Package labeling might also direct the selection of healthier choices among the less expensive items within a food group.

Canadian farmers' perceptions of social sustainability in agriculture

Sustainable food production is an important part of dietetic education and training; however, the focus in the dietetic sphere is often on the environmental aspect. Understanding the multi-dimensional nature of sustainability can enhance dietetic students' sustainability competences-such as empathy and change of perspective, systems thinking, and critical thinking and analysis-to help them in their future careers and strengthen their position in society as trusted and knowledgeable food and nutrition professionals. Enhancing public understanding of sustainable food production is imperative as populations become more urban, are less connected to agriculture, and have expectations for sustainably grown/raised food, often without knowing current food production practices or the multiple aspects of sustainability that must be in place for farmers to meet those demands. The goal of this research was to understand Canadian farmers' perceptions of environmental, economic, and social aspects of sustainable food production. Employing a descriptive qualitative approach and constant comparative analysis, four food and nutrition researchers analyzed interviews from 52 farmers from across Canada. Participants had to be English-speaking, produce food through farming on land, and own or rent the land on which they farm. Telephone/video interviews revealed five overarching social themes: (1) the importance of community and social capital, (2) public perception and social license to operate, (3) lack of infrastructure, and (4) deep connections to personal lives. The final theme, mental health issues (5), reflected the consequences of the multiple sources of stress that can undermine the social sustainability of farmers, farm communities, and food production. These findings may help various audiences appreciate the multiple dimensions of sustainable food production; reflect on their values, perceptions, and actions with regard to agriculture; and enhance their compassion and empathy for all farmers.

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

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

Impact of consuming an environmentally protective diet on micronutrients: a systematic literature review

BACKGROUND

A global move toward consumption of diets from sustainable sources is required to protect planetary health. As this dietary transition will result in greater reliance on plant-based protein sources, the impact on micronutrient (MN) intakes and status is unknown.

OBJECTIVE

Evaluate the evidence of effects on intakes and status of selected MNs resulting from changes in dietary intakes to reduce environmental impact. Selected MNs of public health concern were vitamins A, D, and B12, folate, calcium, iron, iodine, and zinc.

METHODS

We systematically searched 7 databases from January 2011 to October 2022 and followed the PRISMA guidelines. Eligible studies had to report individual MN intake and/or status data collected in free-living individuals from the year 2000 onward and environmental outcomes.

RESULTS

From the 10,965 studies identified, 56 studies were included, mostly from high-income countries (n = 49). Iron (all 56) and iodine (n = 20) were the most and least reported MNs, respectively. There was one randomized controlled trial (RCT) that also provided the only biomarker data, 10 dietary intake studies, and 45 dietary modeling studies, including 29 diet optimization studies. Most studies sought to reduce greenhouse gas emissions or intake of animal-sourced foods. Most results suggested that intakes of zinc, calcium, iodine, and vitamins B12, A, and D would decrease, and total iron and folate would increase in a dietary transition to reduce environmental impacts. Risk of inadequate intakes of zinc, calcium, vitamins A, B12 and D were more likely to increase in the 10 studies that reported nutrient adequacy. Diet optimization (n = 29) demonstrated that meeting nutritional and environmental targets is technically feasible, although acceptability is not guaranteed.

CONCLUSIONS

Lower intakes and status of MNs of public health concern are a potential outcome of dietary changes to reduce environmental impacts. Adequate consideration of context and nutritional requirements is required to develop evidence-based recommendations. This study was registered prospectively with PROSPERO (CRD42021239713).

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.

Utilising emerging perspectives at the global and regional level to frame multisectoral nutrition governance landscape in Kenya

OBJECTIVE

Multisectoral nutrition governance (MNG) is a vital enabling determinant of improved nutrition outcomes. Despite this, it remains to be a complex phenomenon that lacks adequate understanding, especially in developing countries like Kenya. This narrative review aims to discuss the evolution of MNG, the current state of MNG, barriers and challenges, and based on these identify entry points for improvement within the complex governance structure in Kenya.

DESIGN

The Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to ensure rigorous and transparent identification of literature and interpretation.

SETTING

Kenya and developing countries with similar contexts.

PARTICIPANTS

The review included forty-five documents (peer-reviewed articles and grey literature) that reported on MNG in developing countries.

RESULTS

We acknowledge that MNG is a complex and evolving determinant of better nutrition outcomes. The paper highlights challenges Kenya and other developing countries face such as inadequate leadership, inadequate coordination, insufficient capacity, inadequate monitoring and evaluation systems, and limited financial resources, among others. For Kenya in particular, there is inadequate understanding of what MNG is and how it can be effectively operationalised and tracked.

CONCLUSIONS

To enhance understanding of MNG in Kenya, a country-specific assessment of MNG processes and impact outcomes using standard tools and defined metrics is vital. Such assessment will generate evidence of progress, successes, and challenges that will compel the government and stakeholders to invest more in multisectoral nutrition approaches to achieve its nutrition goals.

Co-Designing Research for Sustainable Food Systems and Diets with Aboriginal Communities: A Study Protocol

(1) Background: Food choices and systems have contributed to various health and environmental issues, resulting in the global syndemic (obesity, undernutrition and climate change). Studies show that revitalizing Indigenous food systems and including native plant-based foods in our diet may be important for promoting health, reducing diet-linked chronic diseases and mitigating environmental changes. However, it is still a challenge to 'Indigenize' research by including Aboriginal people in all project phases to achieve culturally appropriate collaboration. We describe the development of a protocol using co-design methods to explore how knowledge can be exchanged around Aboriginal food practices related to native plant-based foods to facilitate benefits and share opportunities for sustainable food systems and Aboriginal aspirations, as well as to promote health in these communities. (2) Methods: This qualitative study includes five phases. In Phase I, we will start building a trusting relationship with the communities and train the research team. In Phase II, we will receive the consent to co-design and establish the Aboriginal Reference Group to ensure that Aboriginal people will lead this project. In Phase III, the investigators will run the interviews/focus groups and record the discussions about the community's place-based needs, understanding the community aspirations for a sustainable food system and the potential opportunities for doing research and strengthening community between research and community. In Phase IV, the records will be analyzed with the Aboriginal Reference Group, and summaries will be shared with community members. Phase V will establish case studies to support the implementation of community aspirations. (3) Discussion: This study protocol describes the process of ensuring that research for sustainable food systems meets Indigenous aspirations and health promotion in Indigenous communities.

Adherence to the Planetary Health Diet Index and correlation with nutrients of public health concern: an analysis of NHANES 2003-2018

BACKGROUND

The Planetary Health Diet Index (PHDI) is a novel measure adapted to quantify alignment with the dietary evidence presented by the EAT-Lancet Commission on Food, Planet, Health.

OBJECTIVES

To examine how population-level health and sustainability of diet as measured by the PHDI changed from 2003 to 2018, and to assess how PHDI correlated with inadequacy for nutrients of public health concern (iron, calcium, potassium, and fiber) in the United States.

METHODS

We estimated survey-weighted trends in PHDI scores and median intake of PHDI components in a nationally representative sample of 33,859 adults aged 20+ y from 8 cycles (2003-2018) of the National Health and Nutrition Examination Survey with 2 d of dietary recall data. We used the National Cancer Institute method to examine how PHDI correlated with inadequate intake of iron, calcium, potassium, and fiber.

RESULTS

Out of a theoretical range of 0-140, the median PHDI value increased by 4.2 points over the study period, from 62.7 (95% confidence interval [CI]: 62.0, 63.4) points in 2003-2004 to 66.9 (66.2, 67.7) points in 2017-2018 (P-trend < 0.001), although most of this change occurred before 2011-2012 and plateaued thereafter. For adequacy components that are encouraged for consumption, nonstarchy vegetable intake significantly decreased over time, whereas whole grains, nuts and seeds, and unsaturated oils increased. For moderation components with recommended limits for consumption, poultry and egg intake increased, but red and processed meat, added sugars, saturated fats, and starchy vegetables decreased over time. Higher PHDI values were associated with a lower probability of iron, fiber, and potassium inadequacy.

CONCLUSIONS

Although there have been positive changes over the past 20 y, there is substantial room for improving the health and sustainability of the United States diet. Shifting diets toward EAT-Lancet recommendations would improve nutrient adequacy for iron, fiber, and potassium. Policy action is needed to support healthier, more sustainable diets in the United States and globally.

Fix my food: An urgent call to action from adolescents on how they experience and want to see change in their food systems

BACKGROUND

Global food systems are failing adolescents. Poor diet quality driving malnutrition among adolescents around the world and the quality of foods eaten by adolescents not only determines their health and development, but also is the foundation of thriving communities. The present study aimed to engage adolescents across low-income, middle-income and high-income countries to determine their lived experience of food, food systems and the challenges they face within their food systems.

METHODS

The study used the Distributed Data Generation method pioneered by the Young and Resilient Research Centre, at Western Sydney University, to conduct workshops with adolescents aged 10-19 years across the globe in collaboration with UNICEF. Participatory workshops were designed to capture qualitative data on adolescents lived experiences and perspectives of their food systems, food sustainability and food security, and how improvements can be made. Thematic analysis was undertaken to analyse qualitative data. Descriptive statistics were generated for demographic data captured.

RESULTS

Six hundred and forty adolescents across 18 countries participated. Three key themes emerged, which included experiences of food, challenges to food systems and strengthening food systems. Adolescents saw potential in empowering communities to create change and contribute to food system transformation. Adolescents called for inclusion in decision-making from local food practice to large global policy development.

CONCLUSIONS

The study results demonstrated how adolescents experience their food systems and want to see sustainable change, although they also want to be a part of the change. Adolescents described that there needs to be an active choice to work with them, listen to their lived experience and across all levels of society strengthen food systems. To achieve this, adolescents need to be involved in decision-making around their food systems for a sustainable future.

Nurturing Sustainability and Health: Exploring the Role of Short Supply Chains in the Evolution of Food Systems-The Case of Poland

Over the last few decades, short food supply chains and local food markets, where farmers either sell their products directly to consumers or use a limited number of intermediaries, have developed worldwide in rural and urban areas. They complement conventional, often globalized, long food chains where small farmers have little bargaining power, and consumers cannot link the food they buy to a known agricultural producer or geographical area where the food is produced. The advantage of direct sales is that producers can obtain a higher price while consumers have easier access to fresh and seasonal food products. The main aim of the paper is to identify and characterize the spatial concentration of local food systems in Poland and their importance in sustainable development and food policy for healthy eating. As part of this study, an analysis of the statistical data of the Central Statistical Office for 2021 was carried out. Data obtained from the Chief Veterinary Inspectorate as of mid-2021 were analyzed to discuss the topic in detail. Descriptive methods and comparative analyses were used to understand regional differences. Absolute and proportional values were used for the research to enable better comparisons between regions, using the traditional method used in spatial structure studies, i.e., the distribution index (number of entities per 1000 inhabitants). The analysis identified spatial differences and possible implications for food policy and regional development. In addition, data on the number of marketplaces in Polish regions in 2022 were used. The study results indicated that short supply chains in the Polish food system contribute to increasing the availability of healthy local products, which may improve consumer health. However, despite these benefits, the results revealed challenges such as the limited production scale of local suppliers and the need to adapt to changing market conditions.

Dietary protein recommendations to support healthy muscle ageing in the 21st century and beyond: considerations and future directions

This review explores the evolution of dietary protein intake requirements and recommendations, with a focus on skeletal muscle remodelling to support healthy ageing based on presentations at the 2023 Nutrition Society summer conference. In this review, we describe the role of dietary protein for metabolic health and ageing muscle, explain the origins of protein and amino acid (AA) requirements and discuss current recommendations for dietary protein intake, which currently sits at about 0⋅8 g/kg/d. We also critique existing (e.g. nitrogen balance) and contemporary (e.g. indicator AA oxidation) methods to determine protein/AA intake requirements and suggest that existing methods may underestimate requirements, with more contemporary assessments indicating protein recommendations may need to be increased to >1⋅0 g/kg/d. One example of evolution in dietary protein guidance is the transition from protein requirements to recommendations. Hence, we discuss the refinement of protein/AA requirements for skeletal muscle maintenance with advanced age beyond simply the dose (e.g. source, type, quality, timing, pattern, nutrient co-ingestion) and explore the efficacy and sustainability of alternative protein sources beyond animal-based proteins to facilitate skeletal muscle remodelling in older age. We conclude that, whilst a growing body of research has demonstrated that animal-free protein sources can effectively stimulate and support muscle remodelling in a manner that is comparable to animal-based proteins, food systems need to sustainably provide a diversity of both plant and animal source foods, not least for their protein content but other vital nutrients. Finally, we propose some priority research directions for the field of protein nutrition and healthy ageing.

Opportunities to improve population health: possibilities for healthier food environments

The recent Covid-19 pandemic highlighted stark social inequalities, notably around access to food, nutrition and to green or blue space (i.e. outdoor spaces with vegetation and water). Consequently, obesity is socio-economically patterned by this inequality; and while the environmental drivers of obesity are widely acknowledged, there is currently little upstream intervention. We know that living with obesity contributes to increasing health inequalities, and places healthcare systems under huge strain. Our environment could broadly be described obesogenic, in the sense of supporting unhealthful eating patterns and sedentary behaviour. Evidence points to the existence of nearly 700 UK obesity policies, all of which have had little success. Obesity prevention and treatment has focused on educational and behavioural interventions targeted at individual consumers. A more sustainable approach would be to try and change the environments that promote less healthy eating and high energy intake as well as sedentary behaviour. Approaches which modify the environment have the potential to assist in the prevention of this complex condition. This review paper focuses on the role of wider food environments or foodscapes. While there is an imperfect evidence base relating to the role of the foodscape in terms of the obesity crisis, policy, practice, civic society and industry must work together and take action now, in areas where current evidence suggests change is required. Despite the current cost-of-living crisis, shaping the foodscape to better support healthful eating decisions has the potential to be a key aspect of a successful obesity prevention intervention.

How the EAT-Lancet Commission on food in the Anthropocene influenced discourse and research on food systems: a systematic review covering the first 2 years post-publication

In 2019, the EAT-Lancet Commission's report on food in the Anthropocene presented a planetary heath diet to improve health while reducing the environmental effect of food systems globally. We assessed EAT-Lancet's immediate influence on academic research and debate by conducting a systematic review of articles citing the Commission and others published from January, 2019, to April, 2021. The Commission influenced methods, results, or discourse for 192 (7·5%) of 2560 citing articles, stimulating cross-disciplinary research and debate across life sciences (47%), health and medical sciences (42%), and social sciences (11%). Sentiment analysis of 76 critiquing articles indicated that opinions were, on average, more positive than negative. Positive sentiments centred on benefits for informing policy, public health, and raising public awareness. Negative sentiments included insufficient attention to socioeconomic dimensions, feasibility, and environmental effects other than emissions. Empirical articles predominantly evaluated the effects of changed diets or food production on the environment and wellbeing (29%), compared current diets with EAT-Lancet recommendations (12%), or informed future policy and research agendas (20%). Despite limitations in EAT-Lancet's method, scope, and implementation feasibility, the academic community supported these recommendations. A broad suite of research needs was identified focusing on the effects of food processing, socioeconomic and political drivers of diet and health, and optimising consumption or production for environment and health.

How can climate change and its interaction with other compounding risks be considered in evaluation? Experiences from Vietnam

While evaluations play a critical role in accounting for and learning from context, it is unclear how evaluations can take account of climate change. Our objective was to explore how climate change and its interaction with other contextual factors influenced One Health food safety programs. To do so, we integrated questions about climate change into a qualitative evaluation study of an ongoing, multi-sectoral program aiming to improve pork safety in Vietnam called SafePORK. We conducted remote interviews with program researchers (n = 7) and program participants (n = 23). Based on our analysis, researchers believed climate change had potential impacts on the program but noted evidence was lacking, while program participants (slaughterhouse workers and retailers) shared how they were experiencing and adapting to the impacts of climate change. Climate change also interacted with other contextual factors to introduce additional complexities. Our study underscored the importance of assessing climate factors in evaluation and building adaptive capacity in programming.

The climate crisis is here: a primer and call to action for public health nutrition researchers and practitioners in high-income countries

Dietary behaviours and the food systems in which they occur have a significant impact on climate change. The 2022 Intergovernmental Panel on Climate Change (IPCC) reports and other major climate reports have identified population-level dietary shifts towards balanced, sustainable healthy diets as an important mitigation (i.e. prevention) solution for climate change. Thus, public health nutrition researchers and practitioners have a crucial role to play in combatting the climate crisis. They have the content expertise, interdisciplinary training and technical skills needed to facilitate wide-scale dietary behaviour changes at multiple levels of influence and ultimately improve both human and planetary health. This commentary article: (i) summarises how dietary behaviours and food systems contribute to climate change, with a particular focus on high-income countries; (ii) reviews food-system-related climate change mitigation solutions most relevant to public health nutrition researchers and practitioners; and (iii) identifies key gaps in the literature and future research directions for the field.

Interlinkages between Climate Change and Food Systems: The Impact on Child Malnutrition-Narrative Review

The pandemics of obesity, undernutrition, and climate change represent severe threats to child health. They co-occur; interact with each other to produce sequelae at biological, psychological, or social levels; and share common underlying drivers. In this paper, we review the key issues concerning child diet and nutritional status, focusing on the interactions with climate and food systems. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services are the leading causes of malnutrition across generations. Food system industrialization and globalization lead to a double burden of malnutrition, whereby undernutrition (i.e., stunting, wasting, and deficiencies in micronutrients) coexists with overweight and obesity, as well as to harmful effects on climate. Climate change and the COVID-19 pandemic are worsening child malnutrition, impacting the main underlying causes (i.e., household food security, dietary diversity, nutrient quality, and access to maternal and child health), as well as the social, economic, and political factors determining food security and nutrition (livelihoods, income, infrastructure resources, and political context). Existing interventions have the potential to be further scaled-up to concurrently address undernutrition, overnutrition, and climate change by cross-cutting education, agriculture, food systems, and social safety nets. Several stakeholders must work co-operatively to improve global sustainable nutrition.

Evaluation of adherence to the Mediterranean diet with sustainable nutrition knowledge and environmentally responsible food choices

Background

Dietary patterns and their possible effects on health and the environment are becoming increasingly important. It is thought that nutritionally balanced diets can also be compatible with environmental targets and, therefore, the Mediterranean diet (MD), which is regarded as a sustainable diet model, comes to the fore. This study was carried out to evaluate adherence to the MD with sustainable nutrition knowledge and environmentally responsible food choices and to determine the factors affecting adherence.

Methods

A questionnaire prepared by the researchers was sent to individuals online and 1732 adults living in Turkey participated in this cross-sectional study. Adherence to the MD was evaluated with the Mediterranean Diet Adherence Screener (MEDAS). In addition, questions were asked about nutritional knowledge and environmentally responsible food choices to evaluate the sustainable nutritional behaviors of individuals.

Results

Half of the participants (51.1% of men / 53% of women) adhere to the MD at a moderate level. Even the individuals with the highest adherence to the MD had low compliance with the recommendations for fruit (43.4%) and fish (37.3%) consumption. A one-unit increase in age, sustainable nutrition knowledge score, and environmentally responsible food choices score increases the MD adherence score by 0.08, 0.125, and 0.148 points, respectively (p < 0.005). Individuals with high adherence to the MD avoid consuming genetically modified organism food more (p < 0.001), prefer to consume environmentally labeled foods (p < 0.001), and buy food more from local businesses (p < 0.001), while they prefer to buy imported food less (p = 0.034).

Conclusion

The results of this study showed that some strategies should be developed to increase the adaptation of individuals to the MD and sustainable nutritional behaviors. Nutritionally adequate, sustainable, and eco-friendly nutritional behaviors should be encouraged to increase the possible health benefits of nutrition and minimize environmental effects. To promote sustainable nutrition, firstly it is important to determine the knowledge level of individuals concerning sustainable nutrition and, for this purpose, it is thought that an international valid sustainable nutrition knowledge assessment tool is needed.

Five U.S. Dietary Patterns and Their Relationship to Land Use, Water Use, and Greenhouse Gas Emissions: Implications for Future Food Security

The U.S. agri-food system is a driver of climate change and other impacts. In order to achieve environmental targets that limit global mean temperature rise ≤2 °C, a shift in American dietary patterns is critical. The purpose of this study was twofold: (1) to determine the environmental impact (i.e., land use, water use, and GHG emissions) related to consumption of five U.S. dietary patterns (i.e., Current U.S., the Healthy U.S., Mediterranean, Healthy Vegetarian, and Vegan), and (2) to determine the specific impact of each food group in each dietary pattern on the three environmental indicators. This study utilized existing datasets to synthesize information related to the study's environmental indicators and food production and connected these data to the current U.S. diet and the USDA-defined diets. Results indicate that the three omnivore diets contributed the greatest to GHG emissions, land use and water use. The Vegan diet scored the lowest across all indicators, although the water required for plant-based protein nearly offset other water gains. For the omnivore diets, red meat and dairy milk contributed the most to each environmental indicator. By considering sustainability as well as health outcomes in their recommendations in the Dietary Guidelines, the USDA can have a critical role in shifting diets necessary to alter climate change trends.

Maternal and child nutrition in the Lives Saved Tool: Results of a recent update

Background

The Lives Saved Tool (LiST) is a mathematical modelling tool for estimating the survival, health, and nutritional impacts of scaling intervention coverage in low- and middle-income countries (LMICs). Various nutrition interventions are included in LiST and are regularly (and independently) reviewed and updated as new data emerge. This manuscript describes our latest in-depth review of nutrition evidence, focusing on intervention efficacy, appropriate population-affected fractions, and new interventions for potential inclusion in the LiST model.

Methods

An external advisory group (EAG) was assembled to review evidence from systematic reviews on intervention-outcome (I-O) pairs for women and children under five years of age. GRADE quality was assigned to each pair based on a LiST-specific checklist to facilitate consistent decisions during the consideration. For existing interventions with new information, the EAG was asked to recommend whether to update the default efficacy values and population-affected fractions. For the new interventions, the EAG decided whether there was sufficient evidence of benefit, and in affirmative cases, information on the efficacy and affected fraction values that could be used. Decisions were based on expert group consensus.

Results

Overall, the group reviewed 53 nutrition-related I-O pairs, including 25 existing and 28 new ones. Efficacy and population-affected fractions were updated for seven I-O pairs; three pairs were updated for efficacy estimates only, three were updated for population-affected fractions only; and nine new I-O pairs were added to the model, bringing the total of nutrition-related I-O pairs to 34. Included in the new I-O pairs were two new nutrition interventions added to LIST: zinc fortification and neonatal vitamin A supplementation.

Conclusions

For modelling tools like LiST to be useful, it is crucial to update interventions, efficacy and population-affected fractions as new evidence becomes available. The present updates will enable LiST users to better estimate the potential health, nutrition, and survival benefits of investing in nutrition.

Environmental sustainability in national food-based dietary guidelines: a global review

Food-based dietary guidelines (FBDGs) provide country-specific guidance on what constitutes a healthy diet. With increasing evidence for the synergy between human and planetary health, FBDGs have started to consider the environmental sustainability of food choices. However, the number of countries that discuss environmental sustainability in their guidelines is unknown. The purpose of this Review was to identify countries with government-endorsed FBDGs that made explicit mention of environmental sustainability and to examine the breadth and depth of the inclusion of sustainability in FBDGs. The Food and Agriculture Organization of the UN identified 95 countries with FBDGs. We assessed 83 countries against our inclusion criteria, of which 37 mentioned environmental sustainability. Relevant content was assessed against a set of criteria based on the Food and Agriculture Organization's guiding principles for sustainable healthy diets. The depth to which environmental sustainability was discussed varied and it was often restricted to general explanations of what a sustainable diet is. Few FBDGs addressed why sustainability is important, how dietary changes can be made, or provided quantified advice for implementing sustainable diets.

Recognizing the importance of protein quality in an era of food systems transformation

A transformation of current food systems is needed to nourish the growing global population in more sustainable ways. To support this, some are advocating for a shift to plant-based or -exclusive diets. These recommendations – typically borne out of concerns for the environment – often fail to account for unintended nutritional consequences, which could be particularly pronounced for protein intake. While there is enough protein to meet current global needs, the issue of protein quality is often overlooked and oversimplified. High-quality protein, including from animal source foods (ASF), is needed to meet nutritional demands in low- and middle-income countries (LMIC), particularly among vulnerable population groups. In high-income countries (HIC), protein quality is important for at-risk populations who have higher protein requirements and lower energy and/or protein intakes. Further, as the global population increases, driven primarily by population growth in LMIC, it is possible that protein production will need to increase in HIC to support exports to help feed the global population. The global dialogue and resulting dietary recommendations must therefore become more nuanced to consider the interaction between nutritional value and environmental impact to help better reflect trade-offs across multiple domains of sustainability. Nutritional life cycle assessments are one way to help accomplish this nuance and evaluate how all types of food production systems should be refocused to improve their environmental efficiency and nutritional impact.

Global Trends in the Availability of Dietary Data in Low and Middle-Income Countries

Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.

Establishing a Common Nutritional Vocabulary - From Food Production to Diet

Informed policy and decision-making for food systems, nutritional security, and global health would benefit from standardization and comparison of food composition data, spanning production to consumption. To address this challenge, we present a formal controlled vocabulary of terms, definitions, and relationships within the Compositional Dietary Nutrition Ontology (CDNO, www.cdno.info) that enables description of nutritional attributes for material entities contributing to the human diet. We demonstrate how ongoing community development of CDNO classes can harmonize trans-disciplinary approaches for describing nutritional components from food production to diet.

Ultra-Processed Foods Elicit Higher Approach Motivation Than Unprocessed and Minimally Processed Foods

Background

Ultra-processed foods (UPF) are becoming extensively available in the food environments. UPF are industrial formulations that are designed to maximize palatability and consumption through a combination of calorie-dense ingredients and chemical additives. UPFs are also aggressively marketed, which may make them more attractive than unprocessed/minimally processed foods (UMPF). Since consumers' purchase decisions are guided by food-evoked emotions, we aimed to provide evidence that UPF visual cues trigger higher emotional responses and approach motivation than UMPF visual cues, with potential impacts on individuals' intention to consume the UPF over the UMPF.

Methods

Participants (n = 174; 144 women; mean age = 20.7 years; standard deviation = 4.35) performed two tasks. In the first task, 16 pictures of foods (8 UPF and 8 UMPF), and 74 pictures from other affective categories, were presented. After viewing each picture, the participants rated it along two basic dimensions of emotion through the Self-Assessment Manikin scale: pleasantness and arousal. In the second task, the participants viewed the same food pictures, and they rated their intention to consume the foods depicted in the pictures. Each picture was plotted in terms of its mean pleasantness and arousal ratings in a Cartesian plane, which resulted in an affective space.

Results

Pictures of UPF and UMPF were positioned in the upper arm of the boomerang-shaped affective space that represents approach motivation. Pictures containing UPF triggered higher approach motivation and intention to consume than pictures containing UMPF. We also found a stronger association between emotional responses and intention to consume UPF relative to UMPF.

Conclusion

These results shed new light on the role of ultra-processed foods evoked emotions that contribute to less healthy and sustainable food environments.