Nudging consumer food choice

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Helping consumers to make healthier, more sustainable food choices is a target for many retailers. A recent scientific article has investigated the efficacy of various “nudging” techniques in cafeteria settings.

Nudging involves deliberately changing how choices are presented to consumers to influence their decision. In this study, the authors changed how cafeteria meal choices were presented to consumers in eight cafeterias in schools, universities, businesses, and hospitals in Germany, on two occasions three years apart.

The authors used an existing sustainability calculator that includes both environmental and health data to determine the most sustainable choice on a menu.

The nudges trialled were placing the most sustainable dish in the best position on the service counter; placing it at the top of the menu; giving it a more descriptive name; and adding sustainability labels with or without full explanation of the sustainability of the dish.

Simply placing an item in the best counter position led to a 22.5% increase in selection above baseline in the first study, but this dropped to 11.6% in a second study three years later (2019/2020). Extensive sustainability labelling and explanations had no effect on sales in the first study but resulted in a 15.9% increase in sales in the second study. The remaining nudges either had no significant impact, or actually led to sales decreases.

These results can be useful to those in the food service industry with an interest in increasing sustainable choices. The authors cite increasing sustainability awareness and consumer interest as a possible reason for the success of the extensive sustainability labels in the second study only. Counter position was by far the most successful approach, and also the easiest for the cafeterias to implement.

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Calcium deficiency at the global, national, and individual levels

This Thought for Food is part of a series on key nutrients identified as global challenges by the SNi DELTA Model®.

Calcium is an essential dietary nutrient: a trace element that is vital for healthy bodily function. However, a recent report composed by the Calcium Task Force (created by New York Academy of Sciences in partnership with the Children’s Investment Fund Foundation) has identified widespread global calcium deficiency. This matches results of the DELTA Model®, which show that global calcium availability from food is only around two-thirds of the global population’s requirement. Here we provide a closer look at the role of dietary calcium, levels of deficiency, and ways forward to improve intakes.

The Task Force was composed of scientists with expertise in nutrition, particularly around micronutrients and child health. Their report aimed to gather the existing data on calcium deficiency and associated health outcomes to assist policy and dietary interventions to reduce the prevalence of deficiency.

Calcium intakes

About 99% of calcium in the body is in our bones. The rest plays a host of roles in our muscular, hormone and nervous system function, as well as in normal cell function. Calcium has a key skeletal role; therefore, calcium intake is particularly important in childhood and adolescence during bone growth. For all of these functions, calcium becomes important again in later life, such as during pregnancy and for bone retention in older adults.

Dietary calcium requirements are set largely based on bone health outcomes; that is, the intakes of people who have healthy bones are deemed sufficient intakes. This is due to the difficulty of understanding exactly how much calcium a person needs each day. When calcium intake is insufficient to meet bodily requirements, calcium stored in bone is used to maintain the other bodily functions requiring calcium, so no immediate effects are obvious. However, a sustained deficient calcium intake over a long period will to lead to depletion of bone calcium stores.

Another challenge in setting recommended intakes is the role of diet. Food sources of calcium, as well as what else is being eaten at the time of calcium ingestion, impacts calcium bioavailability. Plant antinutrients, such as phytic and oxalic acid, can bind to calcium and make it less easily absorbed by the gut. Vitamin D (another dietary micronutrient) is essential for active calcium absorption, and low vitamin D can increase bone calcium turnover and calcium requirement.

As a result of these challenges, there is variation in recommended intakes depending on which authority you ask: for example, the recommended intake range for infants in the Unites States and Canada is around double that recommended in the United Kingdom. Recommended intakes change as you age, and there is less variation in recommendations for adults – around 800 mg per day for most authorities.

Using the DELTA Model® Nutrient Supply and Density tools, the richest sources of calcium per unit mass are various oilcrops, spices and aquatic plants, all of which make minor contributions to global dietary calcium (<25 mg per person per day). The largest contributor to global calcium availability is dairy, accounting for 49% of global food calcium, or around 300 mg per capita per day. Next are vegetables, at around 100 mg per capita per day, cereals at around 50, and meat at around 25.

Global sources of calcium in 2018 from the DELTA Model® Nutrient Supply tool.

Calcium deficiency

The Task Force report stated that around 3.5 billion people worldwide are at risk of inadequate calcium intake, with the vast majority of these individuals located in Africa and Asia. Calcium deficiency is more widespread in low- and middle-income countries than in high-income nations. For those countries where data is available, it is children, adolescents, and individuals over 50 who are most commonly deficient, with women more likely to be affected than men.

We used the DELTA Model® approach to compare 2018 national nutrient availability data for demographically weighted national calcium requirements. We found that only 33 out of 170 countries had sufficient calcium availability to meet the needs of their populations. This sufficiency ranged from just enough to a 90% calcium surplus in Finland. Most of these countries were in Europe, with a few from Western Asia, as well as the US and Australia.

We found the lowest calcium availability compared to requirement in lower income countries in Africa, the Caribbean and Southeast Asia. In some cases, as little as 16% of population calcium requirement was nationally available (Timor-Leste). While data quality is often poorer for these regions compared to Europe and North America, 77 out of 170 countries had less than half of their calcium requirements available, thus these calculations echo the results found by the Task Force.

Health outcomes

The greatest focus of studies on the health outcomes of calcium deficiency relate to bone health.

Osteoporosis (brittle bones) is linked to extended low calcium intake and increases the risk that bones will break under stress. Osteoporosis disproportionately affects women, particularly over the age of 50. Calcium and vitamin D supplementation have been shown to reduce fracture rates in older people in some clinical trials, but this affect is not always observed. Rickets is a similar condition mostly observed in children and linked to low calcium and/or vitamin D intakes.

Interestingly, despite the fact that lower income countries tend to have lower calcium intakes, they also have lower rates of bone fracture than high intake countries. However, the report authors caution that these lower income countries have poorer quality health data and smaller elderly populations, among other confounding factors. Studies on bone mineral density and fracture risk often show contrasting results between and even within regions. Furthermore, many regions lack data on bone health, making causative associations difficult.

In lower income parts of the world, the impacts of low calcium intake are often overshadowed by shorter-term outcomes of malnutrition, such as anaemia, wasting and stunting, as well as infectious diseases. Of current interest is the potential role of calcium intake in pregnancy disorders of hypertension and related mortalities.

Other research has investigated relationships between calcium intake or supplementation and a broader variety of health outcomes, such as cardiovascular disease, colorectal cancer, and kidney stones, with varied and sometimes contradictory outcomes. Dosage and target population appear to play a role, but there remains much to be understood about the role of calcium in health.

Evidence is mixed on the role of calcium supplementation in various health outcomes, although large health organisations state that intakes within the recommended boundaries should carry no health risk for most populations. Table reproduced from Li et al. 2018

Increasing calcium availability and consumption

While there is still a lack of consensus on the exact calcium intakes necessary for consumption, the number of individuals globally not meeting even the most conservative recommendations merits intervention.

Calcium supplementation is widespread in high-income nations: more than half of US women over the age of 60 received supplements in the early 2000s. Supplementary calcium is absorbed at a similar rate to dietary calcium, but the latter has been shown to have more of an impact on bone health, likely due to the smaller but more frequent intake of calcium in food than in a single supplement dose. Some studies have reported adverse effects of (particularly high) calcium supplementation related to various health outcomes, but the position of large health organisations is that intakes within the boundaries of dietary recommendations should have no adverse effects.

From a food perspective, those countries with the lowest calcium intakes are most commonly those with low dairy intakes. High European dairy consumption matches our results that these countries had the highest 2018 calcium availability. Increasing the consumption of calcium dense foods, such as dairy, nuts, seeds, and whole fish will not only improve calcium intakes, but also the intakes of other essential nutrients, due to the nutrient dense nature of these foods.

Conclusion

The final recommendations of the Task Force report for future work were: to progress towards consensus on the true global prevalence of calcium deficiency; to obtain more data on global calcium intakes, particularly in lower-income, higher-risk countries; and, to clarify the role of calcium in fracture risk and bone mineral density. The authors also noted the challenging absence of some method to determine the calcium status of an individual, given there is currently no single biomarker or health outcome that does so.

What can be said incontrovertibly is that deficient calcium intakes are common worldwide. While the full extent and impact of this deficiency is uncertain, that should not prevent action to improve intakes toward recommended levels.

The SNi team thank Professor Connie Weaver, expert in mineral bioavailability and the role of calcium in human nutrition, for her contributions to this Thought for Food. Prof Weaver was an author on the Task Force report.

WHO evidence review on plant-based diets

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The European Regional Office of the World Health Organisation has released a fact sheet reviewing the evidence for the impact of plant-based diets on health and sustainability. The document was released in response to increasing discussion of the concept of “plant based” foods and diets in the European region. They define such diets as “emphasizing foods derived from plant sources coupled with lower consumption or exclusion of animal products”.

In Europe, non-communicable diseases (NCDs) are the major health concern, with cardiovascular disease alone accounting for more than half of all European deaths. Many NCDs can be linked to diet, and specifically to low consumption of vegetables and fruit. Indeed, in more than half of the European countries, daily vegetable and fruit consumption recommendations are not met.

Several studies have identified the reduced burden of many NCDs, especially diabetes, in the vegetarian and vegan population. They note the generally lower BMI and all-round healthier lifestyle of individuals who choose these diets as a contributing factor, as well as the diets themselves.

Reductions in NCDs from more balanced diets would be expected to have benefits for health, and thus reduce health-care expenditure. Environmentally, there may be benefits to reducing the impacts associated with high consumption of animal-sourced foods, such as greenhouse gas emissions and biodiversity loss.

The greatest risks associated with increasingly plant-based diets are for nutrient intakes. The fact sheet encourages proper planning of these diets to account for the reduced supply and bioavailability of nutrients such as iron, vitamin A, B12 and D, and zinc, as well as choosing foods fortified or supplemented with these nutrients.

The authors also warn against blanket associations between plant-based and healthy. Many highly or ultra-processed foods are plant-based, but not all such foods can be described as healthy. Examples such as imitation meats and milks are given, as highly processed plant-based foods containing added sugars, flavours, colours, emulsifiers, and salt. Little is currently known about the nutritional or health impacts of such foods if forming a major part of the diet, as this is still an emerging product group.

The report concludes that the adoption of plant-based diets can be beneficial, and that even incremental changes towards such diets may have benefits. They recommend that foods in such a diet be chosen that are minimally processed and ensure adequate nutrient intakes. Increasing vegetable and fruit consumption, particularly for those not meeting recommendations, should certainly be a target for European authorities.

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Nutrition research using smartphone apps

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Tracking population dietary habits is notoriously difficult, from cohort recruitment to the patchy recollections of what someone ate 24 hours ago. A recent article in Nature Communications approached diet studies via a freely available smartphone app, allowing a large cohort to be assessed with minimal commitment from the participants.

Data from over a million app users, who added on average nine entries to their digital food record each day for an average 197 days, was matched up with demographic and location data to understand the consumption habits of a US cohort.

Their results matched existing knowledge on food environments and dietary habits: high income, higher education, high supermarket access and low fast-food access (the latter two determined by location), all correlated with lower BMI, higher fruit and vegetable consumption, and lower fast-food consumption. One exception was a slight association between high income and high BMI.

The authors also matched their location data to the predominant ethnic group, which was possible due to the zip code level resolution of the data. Again, these results reinforced existing data on the prevalence of consumption of specific foods, and the prevalence of obesity, but across a broader area than previously possible.

This paper shows the power of repurposing existing digitalised data for nutrition research. Such large, long-term, detailed sampling of the US cohort would have been extremely challenging without the availability of an already popular app. Moreover, the privacy of individuals was protected, and the app developers donated the data from the research, facilitating a more refined understanding of their nutrition.

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The risks of dietary risk studies

Two recent correspondence articles published in The Lancet have highlighted some of the challenges in global dietary intake and risk estimation studies. These studies are held in high regard and widely used, so their quality is of great importance.


The first article highlights the differing estimates of two global dietary intake studies: the Global Dietary Database and the Global Burden of Disease (GBD) study 2017. Both report country-level intakes of food groups among adult populations, but are calculated quite differently: the former largely from aggregated dietary survey data, and the latter largely from national level food availability data.


The outcomes of the two approaches showed wide variation in many countries: more than 10-fold differences in several countries across multiple food groups. Among these were consumption of sugar-sweetened beverages, an important target for reduction. Inaccurate estimation of consumption can lead to inaccurate or disproportionate estimates on public health.


The second article also considers the GBD study, but compares the dietary disease burden estimated in the 2017 study with the recently published 2019 GBD study.
The burden on human health of diets low in fruit, nuts and seeds, vegetables, and specific fatty acids had more than halved. Meanwhile, diets high in red meat moved from the 15th largest contributor to diet related disease burden, to 5th, with 36 times higher deaths attributed to these diets than were found in the 2017 study.


The cause of these changes was altered methods in calculating disease burden. The latest study assumed relationships between high red meat diets and heart disease, breast cancer, stroke, diabetes, and colon cancer, whereas the earlier study only included the last two conditions. It also set zero intake as the optimum for minimising health risk, while the previous study used a moderate intake value. These health associations are contended in the scientific literature, as described fully by the authors . A response has since been published, explaining that the upcoming 2020 study will wind back its estimates on meat following further changes to methodology.


The importance of these global studies of dietary intake and associated health outcomes cannot be questioned: there is an urgent need for this data to inform public health decision making. However, these studies are often among the most widely cited and reused in public health policy, thus their conclusions have far-reaching consequences.
The authors of these articles emphasise the importance of having multiple models to identify areas of uncertainty. The results also highlight the weaknesses of relying solely on food availability data, rather than consumption. The articles feature calls for stronger dietary data in low- and middle-income countries; standardisation of food group classifications and disease burden estimation; and caution when interpreting the reliability of such estimates.

The true cost of food

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Many researchers have proposed scores and methods for reducing the nutritional value of foods down to a single number – as covered in a recent Thought for Food. A new method takes an approach rooted in population dietary intakes.

There are many challenges to this: which nutrients to include? How to weight components without introducing bias? A recent paper has avoided these issues by including all nutrients in the Australia and New Zealand Nutrient Reference Values, weighted by the degree to which the Australian population under- or overconsumes them.


The NRF-ai metric (Nutrient-Rich Food Index – adequate intake) means that foods containing under consumed nutrients like calcium, magnesium, vitamin B6 and zinc will receive higher scores than those containing the same amount of vitamin C or phosphorus, which are consumed at adequate levels by most of the population. Conversely, foods containing free sugars will be penalised, as intake of these is above recommendations in most populations.
The score can be made specific to age and gender groups, as the prevalence of deficiency for each nutrient varies between these groups. Ultimately, this leads to a metric that ranks a food item on its ability to address the nutritional needs of the population.


There are many applications for this metric for comparing foods. In the paper, the author considers the score per $ retail price, to understand the cost-effectiveness of a food for meeting nutritional needs. Per environmental impact examples are also given.


NRF-ai represents an unbiased approach to reducing the nutritional value of a food down to a single number. While this approach still loses information compared to the full nutritional composition, it is still valuable for comparisons between like products. A similar approach is applied by the DELTA Model® for the nutritional value of food items for meeting global nutrient requirements.

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Comparing the environmental cost of foods: Nutritional LCAs

The environmental impact of a food, be that carbon footprint, water use, land use or some other factor, can be estimated by life cycle analysis (LCA). With the environmental impact of food an increasingly important consideration for many consumers, industry and policymakers, the FAO have recently published a report on the challenges and opportunities of nutritional LCAs – those that attempt to capture the nutritional value of food alongside its environmental impact.

LCAs are strongest when used to identify hotspots or areas for improvement within the supply chain for a single item. They can be used to answer industry questions like: where should we act first to lower the footprint of our product? They can also be used in comparisons between two otherwise identical products for consumers: which one should I buy? However, challenges arise when LCAs are used to compare the impacts of very different products.

Take Energy Rating labels on electrical appliances as an example. Analogous to LCAs, these are an indication of the relative energy usage of a particular model compared with other appliances of the same type. These are useful for comparing two refrigerators, but do not really help when comparing refrigerators with freezers. They are even less useful when comparing a refrigerator with a washing machine: the appliances have completely different functions, and a purchaser would be unlikely to use them to choose which of the two to take home.

Even within the category of refrigerators, ratings become less relevant when comparing different size models, as they provide a different level of service. Without considering the service or benefit provided by the product we do not have a fair basis on which to compare the footprint or cost of providing that service.

The same problem exists when comparing foods. When we look at the footprint of food products and start making comparisons, we need to be clear on the service or benefit being provided by the products to ensure we are making a valid comparison. However, the service provided by a food item depends on the purpose for which it is consumed.

Food is consumed for a variety of reasons: as a source of nutrition, for sensory experience or pleasure, or for social and cultural purposes. Accounting for these different purposes is not straightforward. For example, from a nutritional perspective, alcoholic beverages provide very little benefit, but many consumers may still place high value on their sensory or social purposes.

The FAO report focuses on nutrition, rather than the other services provided by food, and looks at how nutritional information can be combined with environmental impact data.

One approach is to try and bring together the “benefit” and “cost” into a single analysis: the development of a nutritional LCA (nLCA), a life cycle analysis that includes nutrition.

There are two different methods by which this can be done:

  • As part of the definition of the functional unit (e.g., land use per 100 kcal)
  • As part of the human impact assessment, what is often thought of as the cost side of the analysis (e.g., likely impact on human health)

Neither of these approaches is easy.

Shifting functional units

Often, an LCA uses mass as the functional unit. For example, if considering the water use needed to grow rice, an LCA might report results as “litres of water used per kg of rice”. In this case, the functional unit is “1 kg of rice”.

Putting nutrition into the functional unit moves away from just using mass. In the simplest form, this may be evaluating a set of foods based on the amount of a particular nutrient they contain. Protein is often used for this purpose. Our rice example would then change to “litres of water used per kg protein in rice”.

However, protein is not a single nutrient needed by the body, but rather a collection of amino acids, which are the essential nutrients. Not all proteins are created equal, having both different concentrations of these amino acids and varying in their digestibility. Rice protein is therefore different to soy protein, for example. Thus, comparing water use per kg protein does not capture this information. Sophisticated methods that include protein quality exist, but are challenging and rarely used.

Most food items provide more than one nutrient, and we need a broad range of nutrients to remain healthy. The DELTA Model® estimates the ability of the global food system to supply a basket of 29 nutrients, and would include more given suitable data. Evaluating a food item based on only one target nutrient misses this complexity.

An alternative to selection of a single nutrient as the functional unit is to use a basket of nutrients to create some form of nutrient reference score. The intention of this score would be to provide a more “balanced” view of the nutrition provided by foods. However, what nutrients should make up this score? Do they all have equal weighting? Or are some more important than others? And how does this relate to the needs of an individual? The scientific literature contains many different suggestions, each with their strengths and weaknesses. Each is at risk of introducing some form of bias into the assessment.

Another important consideration is portion size. Once we move away from a functional unit based on mass, we lose some of the context around the amount of food that needs to be consumed to deliver a particular nutrient or group of nutrients, and how that relates to the size of a normal serving. Functional units “per serving” have also been explored, but face the same problems as mass based units.

Bringing human health into the assessment

The alternative approach is to leave the functional unit as the mass of the food item and build the nutritional assessment into the impact side of the LCA. This requires having data on the expected impact of consuming a food for human nutrition or health. The main approach that has been considered to date uses epidemiological data on diets, health, and mortality. This is usually of the kind captured in the Global Burden of Disease (GBD) study, which calculates statistical links between consumption of food groups and expected lifespan or quality of life.

Unfortunately, this data is limited to comparatively coarse effects. The GBD study reports statistical measures for 15 health aspects related to diet and 3 related to nutrient deficiency. The statistical associations are the result of a complex analysis that attempts to isolate the impact of individual food factors on overall outcomes. Changes in assumptions used in the analysis between the 2017 and 2019 data sets resulted in significant changes in the apparent impact of several food groups. These have been highlighted in a recent letter to The Lancet, and would have a major effect on any nLCA employing this data.

In general, the benefits of consumption of food or nutrients follow a curve. Initially there is a positive impact on health, with increasing consumption providing nutrients essential to bodily functions and growth. This benefit is reduced once daily requirements are met, and, if consumption continues to increase, may eventually have negative health outcomes.

This is illustrated with the energy content of diets: eating insufficient calories leads to wasting, but eating too many leads to obesity and a range of related health conditions, and just how much is too few or too many depends upon the need of the individual. Sodium is another example: a diet deficient in sodium can have serious health consequences. However, many diets contain a considerable excess of sodium, carrying health risks for many individuals.

Putting food and nutrients in context

Food items are consumed as part of meals and diets, and it is at this level that we need to apply considerations of nutritional sufficiency. The relative nutritional benefit of consuming a food item varies based on the dietary context of the individual. For example, the protein or amino acid content of a food item may be of limited value in a diet that is otherwise oversupplied with this nutrient, but of immense value in a diet that is deficient.

Within the DELTA Model we have implemented a simple nutrient contribution measure for food items. This is based on the sum of the relative contribution the food item makes to each of the nutrients captured in the model. As such, it gives a higher weighting to nutrients that have low global availability and a lower weighting to nutrients that are abundant.

For example, the default 2018 DELTA Model scenario has a 34% deficiency for calcium against global requirements (achieving 66% of target), whereas phosphorous has a 150% excess (250% of target). Thus, a food that provides 33% of the daily target for calcium gets a score of 0.5, whereas 33% of the daily target of potassium scores only 0.13 – approximately ¼ the importance. A similar approach has recently been published for the individual dietary context.

The right use of nLCA

The challenges described above stem from trying to compare refrigerators with washing machines, and lead us to the fact that nutrition does not easily collapse into a single score.

The scope of comparisons, or the grouping of foods into groups becomes important. If food items are grouped with others that provide or purport to provide similar nutritional benefits, we can make more realistic comparisons that better reflect the real choices facing us.

As an example, we might compare the nutritional LCA of milk with that of a plant beverage and use a nutritional functional unit that reflects the role of these items within the overall diet. Milk products make a significant contribution to the global supply of calcium, phosphorous, and potassium, six indispensable amino acids, dietary fat, overall protein, and vitamins A, B2, B5, and B12. A nutritional functional unit could be designed that reflects this nutritional value to enable us to compare milks and milk-alternatives when consumed as a source of nutrients. However, this same approach would not necessarily be appropriate if the purpose of the product was simply to whiten a cup of coffee. The intended service or benefit of foods must be understood when deciding how to compare costs.

Whilst the concept of a universal nutritional LCA that provides all the information necessary to support a wide range of decisions is attractive in its apparent simplicity, the reality is that nutrition and environmental impacts are too complex, and too important, to be reduced to a single number.

Photo by Victoriano Izquierdo on Unsplash; vector graphics from freesvg.org

The dietary trio of healthy, nutritious and climate-friendly

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A recent study and accompanying editorial have compared dietary nutrient density and diet-related greenhouse gas emissions to understand whether individuals consuming more nutritious diets with lower carbon footprints have a longer lifespan than others.

The short editorial highlights some of the issues in interpreting data for the relationships between mortality and food. Nutrient density, as measured here, can be assessed through multiple metrics. Similarly, climate impact can be measured in many ways, here via greenhouse gas emissions in CO2-equivalents.

Although the impact of nutrition on death rate is an important consideration in assessing the impact of diets on health, it is limited and does not account for broader lifestyle impacts on mortality. 

Similarly, although climate impact is an important consideration in assessing the impact of diet on the environment, land, water, and fertiliser use (among other factors) must also be considered in assessments of the environmental efficiency of diets.

Within these limitations the study found several interesting associations, with notable differences between women and men. 

In the female cohort, mortality was 13% lower for those consuming diets with a high nutrient density and a low climate impact compared to those on low nutrient density and high climate impact diets. However, the same reduction in mortality was found for those consuming diets with a high nutrient density and high climate impact, indicating that nutrient density was the most important factor in the reduced mortality rate.

For men, mortality was 11% higher for diets having a low nutrient density and low climate impact compared to diets having a low nutrient density and high climate impact. It was suggested that this was due to sugar content: sugar has a small climate impact, but a clear negative impact on health when overconsumed.

The editorial makes some useful suggestions for how improvements can be made to such studies, such as considering food intake rather than reducing the assessment to individual nutrients. These results emphasise that climate-friendly diets are not always healthy, and vice versa, but that healthy, climate-positive diets can be achieved.

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Glossary

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Linking agricultural conditions to childhood undernutrition

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A study of infant malnutrition in the West African country of Burkina Faso has established a link between its prevalence and local agricultural conditions.

Climatic conditions play a major role in determining the performance of agricultural land and food production, with local and seasonal variation. The availability of food is an output of this performance, with clear implications for nutrition. In this study, the authors combined household nutrition surveys, malnutrition data and a remotely sensed drought indicator to investigate associations between agricultural conditions and malnutrition.

The Water Requirement Satisfaction Index (WRSI) combines precipitation, temperature, humidity, wind, and solar radiation data to ascertain whether the water needs of an area of cropland are being met. WRSI is a useful risk management tool employed in many parts of the world to study drought and crop yield.

Localised WRSI data was combined with household survey data from Burkina Faso, focusing on 1,721 children aged between 6 months and 2 years old. Around a third of the children were malnourished, as were a quarter of their mothers. Just 15% of the infants had achieved the WHO’s minimum dietary diversity standard over the 24 hours before the survey.

As found by previous studies, undernourished mothers were more likely to have undernourished children in their care. Low dietary diversity, recent diarrhoea, and lower education level of mothers were also associated with malnutrition.

The novel finding of this research was the association between higher WRSI values and reduced chances of malnutrition. These higher values, indicative of regions where the water needs of agricultural production were being met, were also associated with increased infant dietary diversity.

While better agricultural conditions could reasonably be expected to tally with greater food availability and thus reduced rates of malnutrition, studies that consider the interactions between agricultural production due to local climate and nutritional outcomes are rare. These results emphasise the interconnections in our food system – in this case, between rainfall and nutrient adequacy – that have a profound effect on the outcomes for people.

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Commentary on nutritional LCAs

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Dr Bradley Ridoutt, Principal Research Scientist at Australia’s CSIRO and agricultural sustainability researcher, has recently published a commentary on the challenges and opportunities for combining nutritional information with the environmental impacts of food.

Recent years have seen increased efforts to compare the environmental impacts via life cycle analysis (LCA) of food to lead diets and production down more environmentally sustainable paths. Dr Ridoutt highlights that, as yet, no universal definition or best practice for nutritional LCA exist, leading to discussion (including by the FAO) on what the best approach might be.

In a previous article, we discussed the use of LCA in food sustainability research. The main limitations of the nutritional LCA approach were reiterated in the commentary article. A key question remains: what is the function of food? And thus, how should we compare foods?

As stated by Dr Ridoutt, “Foods contain a variety of nutrients, and a healthy diet requires a variety of foods.” Defining an appropriate way to compare the worth of different foods is challenging, which makes incorporating this with environmental impact (fraught with its own challenges of what factors to include), nearly impossible. Dr Ridoutt notes that the further inclusion of the health outcomes of food, often contested, adds to this challenge.

A key quote in the article is “…wrapping environmental LCA results together with nutritional epidemiological findings would appear unlikely to inform wise decision-making and will most likely only benefit individuals and organisations with a social or commercial agenda to promote.” The author concludes that only through separate reporting of the nutritional and environmental impacts of food can trade-offs be identified and assessed. Given that the relative importance of these two impact categories will vary between individual perspectives, this area seems likely to be highly discussed for the foreseeable future.

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Glossary

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