To evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet in a representative sample of the Brazilian population.

The study used data from the Brazilian National Dietary Survey 2017–2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively.

Nationally representative sample of the Brazilian population.

The study included 46 164 Brazilians ≥ 10 years old.

The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT-Lancet diet. The PHDI total score was 5·38 points lower (95 % CI –6·01, –4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods.

Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

Dietary environmental impact in a Norwegian adult population was estimated for six environmental impact categories. Moreover, environmental benefits of scenario diets complying with the Norwegian Food-Based Dietary Guidelines (FBDG) and the EAT-Lancet reference diet were assessed.

The current diet of Norwegian adults was estimated according to 24-h dietary recall data from a national dietary surveillance survey (Norkost 3). Scenario diets were modelled to represent the Norwegian FBDG and the EAT-Lancet healthy reference diet. Dietary environmental impact in terms of global warming potential, freshwater and marine eutrophication, terrestrial acidification, water use and transformation and use of land was estimated for the current and scenario diets using environmental impact data representative of the Norwegian market. Significant associations between impact and gender/educational attainment were assessed at P < 0·05.

Norway.

Adults (n=1787) aged 18–70 years who participated in the Norkost 3 survey (2010–2011).

Environmental impact varied significantly by gender and educational attainment. The food groups contributing most to environmental impact of Norwegian diets were meat, dairy, beverages, grains and composite dishes. Compared with the current Norwegian diet, the FBDG scenario reduced impacts from 2 % (freshwater eutrophication) to 32 % (water use), while the EAT-Lancet scenario reduced impacts from 7 % (marine eutrophication) to 61 % (land use). The EAT-Lancet scenario resulted in 3–48 % larger reductions in impact than the FBDG scenario.

The Norwegian FBDG, while not as environmentally friendly as the EAT-Lancet reference diet, can still be an important tool in lessening environmental burden of Norwegian diets.

This study aimed to identify the amount of discretionary foods and drinks consumed by Norwegian children and adolescents, describe how such products contribute to the intake of total energy and nutrients, and study the distribution in intake of discretionary foods and drinks across different meals. Secondly, the aim was to explore factors associated with those children and adolescents having the highest consumption of discretionary foods and drinks.

Secondary analysis of data from a national survey of dietary intake among Norwegian children and adolescents.

Schools in fifty randomly selected municipalities in Norway.

The study population included 636 pupils in 4th grade (9–11 years) and 687 pupils in 8th grade (12–14 years).

Discretionary foods and drinks contributed to about 20 % of the children and adolescents’ total energy intake. These products contributed to about two-thirds of the participants’ intake of added sugar, and limited amounts of dietary fibre, vitamins and minerals. The quartile which had the lowest proportion of their energy intake from discretionary foods and drinks seemed to have a higher intake of whole grains, and fish and seafood.

Almost all 4th and 8th graders in Norway consumed discretionary foods and drinks, and these products contributed to a substantial proportion of the total energy intake and limited amounts of nutrients. Those children and adolescents consuming the least discretionary foods and drinks had a higher intake of whole grains, fish and seafood, indicating healthier and more sustainable food habits.

Eating a variety of nutritious foods is fundamental to good nutrition. However, this principle is challenged when recommendations seeking to improve the environmental sustainability of diets call for avoidance of foods considered to have a higher environmental footprint, such as animal-sourced foods. Our objective was to assess the implications for nutritional adequacy of protein choice across Australian adult diets preselected as having higher quality and lower environmental impact scores.

Each individual diet was assessed for variety of food choice within the ‘Fresh meat and alternatives’ food group defined in the Australian Dietary Guidelines, which includes protein-rich foods such as eggs, nuts, tofu and legumes in addition to animal meats. Diets were grouped according to variety score and whether they included only animal meats, only alternatives or a variety of meat and alternatives. Nutrient content was assessed relative to estimated average requirements (EAR).

Australia.

1700 adults participating in the Australian Health Survey

For diets with higher diet quality and lower environmental impact, the likelihood of achieving nutrient EAR significantly increased as variety of food choice in the ‘Fresh meat and alternatives’ food group increased (P < 0·001). Variety score and number of serves were also correlated (r = 0·52, P < 0·001) which is relevant since most diets did not meet the recommended minimum number of serves for this food group.

Greater variety within the ‘Fresh meat and alternatives’ food group is beneficial to meeting EAR and lower environmental impact diets can include three or more selections including foods of animal origin.

To compare the nutritional composition of bovine milk and several plant-based drinks with a focus on protein and essential amino acid content and to determine the ratio of essential amino acids to greenhouse gas emission.

Nutritional information on the label was extracted for semi-skimmed milk, soy, oat, almond, coconut and rice drink from the Innova database between January 2017 and March 2020 for the Netherlands, Belgium, Germany, Spain, Italy and Sweden. Protein and amino acids were measured and carbon footprint was calculated for a selection of Dutch products. Protein quality was determined by calculating the contribution to the WHO essential amino acids requirements.

The bovine milk and plant-based drinks market in Netherlands, Belgium, Germany, Spain, Italy and Sweden.

Semi-skimmed bovine milk and soy, oat, almond, coconut and rice drink.

Nutritional label information was collected for 399 products. Milk naturally contains many micronutrients, e.g. vitamin B2, B12 and Ca. Approximately 50 % of the regular plant-based drinks was fortified with Ca, whereas the organic plant-based drinks were mostly unfortified. Protein quantity and quality were highest in milk. Soy drink had the best protein quality to carbon footprint ratio and milk came second.

The nutrition – climate change balance presented in this study, is in line with previous literature, which shows that semi-skimmed bovine milk and fortified soy drink deserve a place in a sustainable diet.

A sustainable diet is an affordable diet with low environmental impact, high food security and sufficient healthiness. The present study aimed to assess the correlation between the socio-economic status of households and a sustainable diet.

The food basket and socio-economic data of Iranian households were evaluated during 2016–2018. The households were classified based on the sustainability of their diet by determining the dietary carbon footprint, dietary water footprint, lower dietary costs of the household than the median and a higher dietary quality index than the median. Logistic regression was used with four models to calculate the OR of a more sustainable diet as the dependent variable regarding the different quartiles of socio-economic status (SES) as the independent variable.

Iran.

Iranian households (n 102 303), nationally representative, were studied.

Lower SES was associated with the higher OR of a sustainable diet (OR: 0·90; (95 % CI 0·87, 0·91)). Higher quartiles of SES compared with the lower SES group indicated the higher energy intake and consumption of more dairies, meat, poultry, fish, eggs, legumes, nuts and fruits, as well as the lower intake of bread, cereal, rice and pasta.

In countries such as Iran, where nutrition transition occurs rapidly, better economic and social levels in the populations with a higher SES are associated with increased energy intake and higher consumption of animal-based foods, which decreases sustainable diets compared with the groups with a lower SES.

Agriculture accounts for around 70 % of global freshwater withdrawals. As such, the food system has been identified as a critical intervention point to address water scarcity. Various studies have identified dietary patterns that contribute less to water scarcity. However, it is unclear what level of reduction is necessary to be considered sustainable. The pursuit of unnecessarily aggressive reductions could limit dietary diversity. Our objective was to assess the sustainability of water use supporting Australian dietary habits and the adequacy of current dietary guidelines.

Dietary intake data were obtained from the National Nutrition and Physical Activity component of the Australian Health Survey. For each individual daily diet, the water scarcity footprint was quantified, following ISO14046:2014, as well as a diet quality score. Water scarcity footprint results were compared with the planetary boundary for freshwater use downscaled to the level of an individual diet.

Australia.

9341 adults participating in the Australian Health Survey.

Dietary water scarcity footprints averaged 432·6 L-eq (95 % CI 432·5, 432·8), less than the 695 litres/person per d available to support the current global population of 7·8 billion, and the 603 litres/person per d available for a future population of 9 billion. Diets based on the Australian Dietary Guidelines required 521 L-eq/d, or 379 L-eq/d with lower water scarcity footprint food choices.

Diets based on the Australian Dietary Guidelines were found to be within the freshwater planetary boundary. What is needed in Australia is greater compliance with dietary guidelines.

To develop and test a tool to assess the price and availability of low-carbon footprint and nutritionally balanced dietary patterns in retail food environments in Ontario, Canada.

Availability and price of selected food from discount and regular grocery stores (n 23) in urban/rural areas of northern/southern Ontario were assessed with the Sustainable Nutrition Environment Measures Survey in 2017.

Ontario, Canada.

Inter-rater reliability was high for price (intra-class correlation coefficients = 0·819) and for availability (Cohen’s κ = 0·993). The tool showed 78 % of the selected food items were available in all stores. Overall, price differences were small between urban and rural locations, and northern and southern Ontario. The greatest price difference was between discount and regular stores.

The tool showed excellent inter-rater agreement. Researchers and public health dietitians can use this tool for research, practice and policy to link consumer-level health outcomes to the retail environment.

Promoting a traditional Mexican diet (TMexD) could potentially reduce high rates of non-communicable diseases (NCD) and support food sustainability in Mexico. This study aimed to develop an index to assess adherence to the TMexD.

A three-round Delphi study was conducted to examine the food groups, specific foods and food-related habits that would constitute a TMexD index. Participants selected the TMexD items using Likert scales, lists of responses, and yes/no questions. Consensus was determined using percentages of agreement, mean values and/or coefficients of variation.

Online Delphi study.

Seventeen nutrition and food experts in Mexico completed all three rounds.

The resulting index (ranging from 0 to 21 points) consisted of 15 food groups, containing 102 individual foods. Food groups included in higher quantities were maize, other grains, legumes, vegetables, fruits, herbs, nuts and seeds, and tubers. Animal foods, vegetable fats and oils, homemade beverages, maize-based dishes, and plain water were also included, but in lower quantities. The food-related habits included were consuming homemade meals, socialising at meals and buying food in local markets. Consensus was reached for all index items apart from quantities of consumption of six food groups (herbs, nuts, grains, tubers, dairy and eggs).

Although future research could improve the measures for which consensus was not reached, the TMexD index proposed in this study potentially displays a healthy and sustainable dietary pattern and could be used to examine links between the TMexD and health outcomes in Mexican populations.

To describe continuity over time in reports of valuing sustainable diet practices and investigate relationships between values, household meal behaviours and dietary intake.

Observational study. Participant ratings of how important it is for food to be produced as organic, not processed, locally grown and not GM were categorized to represent whether they valued (very/somewhat important) or did not value (a little/not at all important) each practice. Diet quality markers (e.g. fruit servings) were based on an FFQ.

Mailed and online surveys.

Young adults (n 1620; 58 % female, mean age 31 (sd 1·6) years) who were participating in Project EAT (Eating and Activity among Teens and Young Adults) and responded to follow-up surveys in 2003–2004 and 2015–2016.

One-third (36·1 %) of participants reported valuing <2 practices at both assessments; 11·1 and 34·5 % respectively reported valuing ≥2 practices in 2003–2004 only and in 2015–2016 only; 18·3 % reported valuing ≥2 practices at both assessments. Regression models including demographics, parental status and vegetarian status showed that valuing ≥2 practices was associated with preparation of meals with vegetables at least a few times/week, less frequent purchase of family meals from fast-food restaurants, and higher diet quality in 2015–2016. For example, those who valued ≥2 practices consumed nearly one full vegetable serving more than other young adults on an average day and part of this difference was specifically associated with intake of dark green and red/orange vegetables.

Addressing the sustainability of food choices as part of public health messaging may be relevant for many young adults.

To obtain a better insight into the conceptualization of sustainable consumption among consumers with special focus on food choice determinants. Previous studies show that people present positive attitude towards sustainable diet while their everyday food choices do not follow sustainable diet rules.

A structured questionnaire was designed and data were collected via computer-assisted telephone interview among a random group (n 600) of city-dwellers. Quota sampling was used in proportion to the city population. Cluster analysis (k-means method) was applied to identify consumer segments according to the determinants of food choices. Consumer segments were identified using one-way ANOVA with post hoc Duncan comparison of mean scores and cross-tabulation with χ2. The Friedman test was applied to identify enablers and barriers of sustainable food choices.

Cities in Mazovia, the best developed, central region of Poland.

Adults (21–70 years old).

Consumers are not familiar with the concept of sustainability and are not able to define it adequately. Only 6 % of the studied population indicated that sustainable consumption is connected with nutrition which has possibly less impact on the environment. Three segments of consumers were distinguished regarding their attitude to food choice determinants adequate to sustainable diet: Non-Adopters (17 %), Emergents (32 %), Adopters (51 %). Desire to improve health by decreasing body weight was the main driver for sustainable food choices, while prices were the main limitation.

Knowledge dissemination on sustainability issues is needed to empower consumers to make more sustainable food choices and to make public health and food policy measures more effective.

Encouraging people to eat more seafood can offer a direct, cost-effective way of improving overall health outcomes. However, dietary recommendations to increase seafood consumption have been criticised following concern over the capacity of the seafood industry to meet increased demand, while maintaining sustainable fish stocks. The current research sought to investigate Australian accredited practising dietitians’ (APD) and public health nutritionists’ (PHN) views on seafood sustainability and their dietary recommendations, to identify ways to better align nutrition and sustainability goals.

A self-administered online questionnaire exploring seafood consumption advice, perceptions of seafood sustainability and information sources of APD and PHN. Qualitative and quantitative data were collected via open and closed questions. Quantitative data were analysed with χ2 tests and reported using descriptive statistics. Content analysis was used for qualitative data.

Australia.

APD and PHN were targeted to participate; the sample includes respondents from urban and regional areas throughout Australia.

Results indicate confusion around the concept of seafood sustainability and where to obtain information, which may limit health professionals’ ability to recommend the best types of seafood to maximise health and sustainability outcomes. Respondents demonstrated limited understanding of seafood sustainability, with 7·5 % (n 6/80) satisfied with their level of understanding.

Nutrition and sustainability goals can be better aligned by increasing awareness on seafood that is healthy and sustainable. For health professionals to confidently make recommendations, or identify trade-offs, more evidence-based information needs to be made accessible through forums such as dietetic organisations, industry groups and nutrition programmes.

Our current food consumption patterns, and in particular our meat and dairy intakes, cause high environmental pressure. The present modelling study investigates the impact of diets with less or no meat and dairy foods on nutrient intakes and assesses nutritional adequacy by comparing these diets with dietary reference intakes.

Environmental impact and nutrient intakes were assessed for the observed consumption pattern (reference) and two replacement scenarios. For the replacement scenarios, 30 % or 100 % of meat and dairy consumption (in grams) was replaced with plant-based alternatives and nutrient intakes, greenhouse gas emissions and land use were calculated.

The Netherlands.

Dutch adults (n 2102) aged 19–69 years.

Replacing 30 % of meat and dairy with plant-based alternatives did not substantially alter percentages below the Estimated Average Requirement (EAR) for all studied nutrients. In the 100 % replacement scenario, SFA intake decreased on average by ~35 % and Na intake by ~8 %. Median Ca intakes were below the Adequate Intake. Estimated habitual fibre, Fe and vitamin D intakes were higher; however, non-haem Fe had lower bioavailability. For Zn, thiamin and vitamin B12, 10–31 % and for vitamin A, 60 % of adults had intakes below the EAR.

Diets with all meat and dairy replaced with plant-based foods lowered environmental impacts by >40 %. Estimated intakes of Zn, thiamin, vitamins A and B12, and probably Ca, were below recommendations. Replacing 30 % was beneficial for SFA, Na, fibre and vitamin D intakes, neutral for other nutrients, while reducing environmental impacts by 14 %.