Global red and processed meat trade and non-communicable diseases

Nutritional and antioxidant potential of Pleurotus djamor (Rumph. ex Fr.) Boedijn produced on agronomic wastes banana leaves and sugarcane bagasse substrates

Global food production faces challenges concerning access to nutritious and sustainably produced food. Pleurotus djamor, however, is an edible mushroom that can be cultivated on agricultural waste. Considering that nutritional and functional potential of mushrooms can change based on cultivation conditions, we examined the influence of substrates with different compositions of banana leaf and sugarcane bagasse on the nutritional, mycochemical, and antioxidant properties of P. djamor. The mushrooms were grown for 120 days and dried in a circulating air oven at 45 °C for three days. We conducted bromatological analyses and mycochemical characterization (1H-NMR, total phenolics, and flavonoids) of the mushrooms and assayed the antioxidant activity of extracts from the dried mushrooms using an ethanol/water solution (70:30 v/v). In general, the substrates produced mushrooms with high protein (18.77 ± 0.24% to 17.80 ± 0.34%) and dietary fiber content (18.02 ± 0.05% to 19.32 ± 0.39%), and with low lipid (0.28 + 0.08% to 0.4 + 0.6%), and caloric content (maximum value: 258.42 + 8.49), with no significant differences between the groups (p ≥ 0.05). The mushrooms also exhibited high levels of total phenolics and flavonoids. The mushrooms cultivated on sugarcane bagasse substrates presented the highest values (p < 0.05). Analysis of the 1H-NMR spectra indicates an abundant presence of heteropolysaccharides, β-glucans, α-glucans, and oligosaccharides, and all the mushroom extracts exhibited high antioxidant activity. In conclusion, our study demonstrates that agricultural residues permit sustainable production of edible mushrooms while maintaining nutritional and functional properties.

Global burden of pancreatic cancer attributable to metabolic risks from 1990 to 2019, with projections of mortality to 2030

OBJECTIVE

Metabolic risks play a key role in the progression of pancreatic cancer. This study aimed to present global, regional and national data on mortality and disability-adjusted life-year (DALY) for pancreatic cancer attributable to metabolic risk and to forecast mortality to 2030 using data from the Global Burden of Disease (GBD).

METHODS

Data on mortality and DALYs due to pancreatic cancer attributable to metabolic risks were obtained from GBD 2019. Metabolic risks include high fasting plasma glucose (FPG) and high body mass index (BMI). Total numbers and age-standardized rates per 100,000 people for mortality and DALYs were reported by age, sex, region and country/territory from 1990 to 2019. The "Bayes age-period-cohort" method was used for projections of mortality to 2030.

RESULTS

Globally, there was a 3.5-fold increase in the number of pancreatic cancer deaths attributable to metabolic risk, from 22,091 in 1990 to 77,215 in 2019. High-income North America and Central Europe had the highest age-standardized mortality rates (ASMRs) of pancreatic cancer attributable to high FPG and high BMI in 2019, respectively. From 1990 to 2019, the global ASMR of pancreatic cancer attributable to high FPG and high BMI increased. Countries with high healthcare access quality had much higher age-standardized DALY rates. In the next 10 years, the ASMR of pancreatic cancer attributable to high FPG and high BMI will continue to increase.

CONCLUSION

Pancreatic cancer mortality and DALYs attributable to metabolic factors remain high, particularly in high-income regions or countries. Studies on the metabolic mechanism of pancreatic cancer and effective treatment strategies are needed.

Unacceptable use of substandard metrics in policy decisions which mandate large reductions in animal-source foods

Many recent very influential reports, including those from the Global Burden of Disease (GBD) Risk Factor Collaborators, the EAT-Lancet Commission on Food, Planet, Health, and the Lancet Countdown on Health and Climate Change, have recommended dramatic reductions or total exclusion of animal-source foods, particularly ruminant products (red meat and dairy), from the human diet. They strongly suggest that these dietary shifts will not only benefit planetary health but also human health. However, as detailed in this perspective, there are grounds for considerable concern in regard to the quality and transparency of the input data, the validity of the assumptions, and the appropriateness of the statistical modelling, used in the calculation of the global health estimates, which underpin the claimed human health benefits. The lessor bioavailability of protein and key micronutrients from plant-source foods versus animal-source foods was not adequately recognised nor addressed in any of these reports. Furthermore, assessments of bias and certainty were either limited or absent. Despite many of these errors and limitations being publically acknowledged by the GBD and the EAT-Lancet authors, no corrections have been applied to the published papers. As a consequence, these reports continue to erroneously influence food policy decisions and international dietary guidelines, such as the World Wildlife Fund's Livewell Diet, and the Nordic Nutrition Recommendations 2023.

Comparing meat and meat alternatives: an analysis of nutrient quality in five European countries

OBJECTIVE

To assess and compare the (macro-)nutritional composition of red meat (RM) and poultry meat (PM) products with the emerging category of meat substitutes.

DESIGN

We use information on nutritional values per 100 g to estimate the differences in the nutritional composition between RM, PM, vegan meat substitute (VMS) and non-vegan meat substitute (NVMS) and derive six unique meat product clusters to enhance the comparability.

SETTING

Meat markets from five major European countries: France, Germany, UK, Italy and Spain.

PARTICIPANTS/DATA

Product innovation data for 19 941 products from Mintel's Global New Product Database from 2010 to 2020.

RESULTS

Most of the innovations in the sample are RM products (55 %), followed by poultry (30 %), VMS (11 %) and NVMS (5 %). RM products exhibit a significantly higher energy content in kcal/100 g as well as fat, saturated fat, protein and salt all in g/100 g than the meatless alternatives, while the latter contain significantly more carbohydrates and fibre than either poultry or RM. However, results differ to a certain degree when products are grouped into more homogeneous clusters like sausages, cold cuts and burgers. This indicates that general conclusions regarding the health effects of substituting meat with plant-based alternatives should only be drawn in relation to comparable products.

CONCLUSIONS

Meat substitutes, both vegan and non-vegan, are rated as ultra-processed foods. However, compared with RM products, they and also poultry products both can provide a diet that contains fewer nutrients-to-limit, like salt and saturated fats.

Arid/semi-arid flora as a treasure trove of bioactives and bioenergy: the case for underutilized desert legumes towards environmental sustainability

As the spectre of climate change gains in strength with each passing moment, many of our mundane food crops like rice face the heat, leading to uncertain yields and unforeseen disease outbreaks. Subsequently, mankind is forced to look for alternative food choices that should primarily come from indigenous plants that are less demanding in terms of usage of water and application of chemical-based fertilizers/pesticides. There are plants growing in the wild in the arid and semi-arid zones of Rajasthan, India, that can come to the rescue, with an added potential for development into valuable functional foods-i.e., not only as source of carbohydrates, proteins, and micro-nutrients but also that of health benefiting nutraceuticals (like antioxidant flavonoids) and relevant enzymes. The other parts (non-edible) of these plants have often also been traditionally validated via diverse ethnomedicinal practices; these could also be useful bioenergy sources. Keeping in mind the broader aim of looking at future functional foods that are also required to be environmentally sustainable, the current report: (a) reviews the extant literature on underutilized legumes from arid/semi-arid zones, (b) discusses current status with respect to biological activities present therein, and (c) suggests pertinent research questions and solution paths in the domains of bioactives, bioenergy, and sustainable environment.

Leveraging the metacoupling framework for sustainability science and global sustainable development

Sustainability science seeks to understand human-nature interactions behind sustainability challenges, but has largely been place-based. Traditional sustainability efforts often solved problems in one place at the cost of other places, compromising global sustainability. The metacoupling framework offers a conceptual foundation and a holistic approach to integrating human-nature interactions within a place, as well as between adjacent places and between distant places worldwide. Its applications show broad utilities for advancing sustainability science with profound implications for global sustainable development. They have revealed effects of metacoupling on the performance, synergies, and trade-offs of United Nations Sustainable Development Goals (SDGs) across borders and across local to global scales; untangled complex interactions; identified new network attributes; unveiled spatio-temporal dynamics and effects of metacoupling; uncovered invisible feedbacks across metacoupled systems; expanded the nexus approach; detected and integrated hidden phenomena and overlooked issues; re-examined theories such as Tobler's First Law of Geography; and unfolded transformations among noncoupling, coupling, decoupling, and recoupling. Results from the applications are also helpful to achieve SDGs across space, amplify benefits of ecosystem restoration across boundaries and across scales, augment transboundary management, broaden spatial planning, boost supply chains, empower small agents in the large world, and shift from place-based to flow-based governance. Key topics for future research include cascading effects of an event in one place on other places both nearby and far away. Operationalizing the framework can benefit from further tracing flows across scales and space, uplifting the rigor of causal attribution, enlarging toolboxes, and elevating financial and human resources. Unleashing the full potential of the framework will generate more important scientific discoveries and more effective solutions for global justice and sustainable development.

Why understanding food choice is crucial to transform food systems for human and planetary health

What, how and why people eat has long been understood to be important for human health, but until recently, has not been recognised as an essential facet of climate change and its effects on planetary health. The global climate change and diet-related health crises occurring are connected to food systems, food environments and consumer food choices. Calls to transform food systems for human and planetary health highlight the importance of understanding individual food choice. Understanding what, how and why people eat the way they do is crucial to successful food systems transformations that achieve both human and planetary health goals. Little is known about how food choice relates to climate. To clarify potential paths for action, we propose that individual food choice relates to climate change through three key mechanisms. First, the sum of individual food choices influences the supply and demand of foods produced and sold in the marketplace. Second, individual food decisions affect type and quantity of food waste at the retail and household level. Third, individual food choices serve as a symbolic expression of concern for human and planetary health, which can individually and collectively stimulate social movements and behaviour change. To meet the dietary needs of the 2050 global population projection of 10 billion, food systems must transform. Understanding what, how and why people eat the way they do, as well as the mechanisms by which these choices affect climate change, is essential for designing actions conducive to the protection of both human and planetary health.

Chronic diseases attributable to a diet rich in processed meat in Brazil: Burden and financial impact on the healthcare system

Background

The consumption of processed meat causes negative impacts on health; however, this burden for the population living in developing countries is less explored. This study aimed to describe the burden of chronic noncommunicable diseases (NCDs) attributed to a diet rich in processed meat between 1990 and 2019 in Brazil and its federative units and the financial burden on the Unified Health System (SUS) in 2019.

Methods

Secondary data from the Global Burden of Disease (GBD) and SUS Information Systems were used in this ecological study. The metrics to assess the burden of NCDs attributable to processed meat consumption were disability-adjusted life years (DALYs) and deaths. The age-standardized rates were presented per 100,000 inhabitants with 95% uncertainty intervals (95% UI). The cost of hospitalizations and outpatient procedures covered by SUS for the treatment of NCDs attributable to processed meat consumption was estimated using the population-attributable fraction. Both burdens were estimated for both sex and stratified by sex, specific cause, and federative units.

Results

The age-standardized DALY rates attributable to a diet rich in processed meat increased between 1990 (75.31/100,000 [95% UI: 34.92–139.65]) and 2019 (79.35/100,000 [95% UI: 42.84–126.25]); while mortality rates remained stable between 1990 (2.64/100,000 [95% UI: 1.17–5.21) and 2019 (2.36/100,000 [95% UI: 1.22–4.09]). The cost of hospitalization and outpatient procedures in Brazil for NCDs attributable to the consumption of processed meat was approximately US$ 9,4 million, of which US$ 6,1 million was spent on ischemic heart disease, US$ 3,1 million on colorectal cancer, and US$ 200 thousand on type 2 diabetes mellitus.

Conclusion

The NCD burden did not decrease during the years evaluated, while the financial burden was high in 2019, with higher treatment costs for ischemic heart disease. These results can guide political, economic, and health education interventions to advance the fight against NCDs.

Dietary Patterns, Occupational Stressors and Body Composition of Hospital Workers: A Longitudinal Study Comparing before and during the COVID-19 Pandemic

This longitudinal study aimed to evaluate the association between dietary patterns and the body composition of hospital workers subjected to occupational stressors before and during the COVID-19 pandemic. Data on sociodemographic, occupational, lifestyle, anthropometric, food consumption and occupational stress were collected before and during the COVID-19 pandemic. A total of 218 workers from a private hospital in Santo Antônio de Jesus, Bahia, Brazil were included in the study. After evaluating the normality of the data, parametric or non-parametric tests were used to characterize the sample. Dietary pattern was defined with Exploratory Factor Analysis and Structural Equation Modeling was used to test the desired association. During the pandemic, work per shift increased by 8.2% (p = 0.004) and working hours > 40 h/week increased by 9.2% (p = 0.006). Despite the higher prevalence of low occupational stress (85.8% vs. 72.1%), high stress increased by 13.7% from 2019 to 2020 (p < 0.001) and 30.3% reported a positive mediating effect on the variables of body composition, body mass index (b = 0.478; p < 0.001), waist circumference (b = 0.395; p = 0.001), fat-free mass (b = 0.440; p = 0.001) and fat mass (b = -0.104; p = 0.292). Therefore, a dietary pattern containing high-calorie foods was associated with changes in the body composition of hospital workers, including occupational stressors as mediators of this relationship.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+23.4% and +1.4%, respectively) and a decrease in fish (-7.1% and -3.2%, respectively). Temporal trends did not agree between the two datasets for dairy, calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are           used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by Defra (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: FAO-FBS estimates were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses . Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Environmental health, COVID-19, and the syndemic: internal medicine facing the challenge

Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. These elements cannot be neglected, and a wide view of public health aspects by a "one-health" approach is strongly and urgently recommended. According to World Health Organization, 35% of infectious diseases involving the lower respiratory tract depend on environmental factors, and infections from SARS-Cov-2 is not an exception. Furthermore, environmental pollution generates a large burden of non-communicable diseases and disabilities, increasing the individual vulnerability to COVID-19 and the chance for the resilience of large communities worldwide. In this field, the awareness of internists must increase, as privileged healthcare providers. They need to gain a comprehensive knowledge of elements characterizing COVID-19 as part of a syndemic. This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.

Health sector solutions for promoting sustainable and nutritious diets

Renzo R Guinto and colleagues discuss why the health sector must embrace the planetary health approach and advocate concrete solutions for fixing the food system

The global burden of type 2 diabetes attributable to high body mass index in 204 countries and territories, 1990-2019: An analysis of the Global Burden of Disease Study

Background

High body mass index (BMI) plays a critical role in the initiation and development of type 2 diabetes (T2D). Up to now, far too little attention has been paid to the global burden of T2D attributable to high BMI. This study aims to report the deaths and disability-adjusted life years (DALYs) of T2D related to high BMI in 204 countries and territories from 1990 to 2019.

Methods

Data on T2D burden attributable to high BMI were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The global cases, age-standardized rates of mortality (ASMR), and disability-adjusted life years (ASDR) attributable to high BMI were estimated by age, sex, geographical location, and socio-demographic index (SDI). The estimated annual percentage change (EAPC) was calculated to quantify the trends of ASMR and ASDR during the period 1990-2019.

Results

Globally, there were 619,494.8 deaths and 34,422,224.8 DALYs of T2D attributed to high BMI in 2019, more than triple in 1990. Moreover, the pace of increase in ASMR and ASDR accelerated during 1990-2019, with EAPC of 1.36 (95% CI: 1.27 to 1.45) and 2.13 (95% CI: 2.10 to 2.17) separately, especially in men, South Asia, and low-middle SDI regions. Oceania was the high-risk area of standardized T2D deaths and DALYs attributable to high BMI in 2019, among which Fiji was the country with the heaviest burden. In terms of SDI, middle SDI regions had the biggest T2D-related ASMR and ASDR in 2019.

Conclusion

The global deaths and DALYs of T2D attributable to high BMI substantially increased from 1990 to 2019. High BMI as a major public health problem needs to be tackled properly and timely in patients with T2D.

Study Protocol: Interactive Dynamics of Coral Reef Fisheries and the Nutrition Transition in Kiribati

The Kiribati 2019 Integrated Household Income and Expenditure Survey (Integrated HIES) embeds novel ecological and human health research into an ongoing social and economic survey infrastructure implemented by the Pacific Community in partnership with national governments. This study seeks to describe the health status of a large, nationally representative sample of a geographically and socially diverse I-Kiribati population through multiple clinical measurements and detailed socio-economic surveys, while also conducting supporting food systems research on ecological, social, and institutional drivers of change. The specific hypotheses within this research relate to access to seafood and the potential nutritional and health benefits of these foods. We conducted this research in 21 of the 23 inhabited islands of Kiribati, excluding the two inhabited islands-Kanton Islands in the Phoenix Islands group with a population of 41 persons (2020 census) and Banaba Island in the Gilbert Islands group with a population of 333 persons (2020 census)-and focusing exclusively on the remaining islands in the Gilbert and Line Islands groups. Within this sample, we focused our intensive human health and ecological research in 10 of the 21 selected islands to examine the relationship between ecological conditions, resource governance, food system dynamics, and dietary patterns. Ultimately, this research has created a baseline for future Integrated HIES assessments to simultaneously monitor change in ecological, social, economic, and human health conditions and how they co-vary over time.