WHO Europe outlines healthy and sustainable diets workstream

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The World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases have released a fact sheet on their workstreams around healthy and sustainable diets. This work is intended to guide European national policy on shifts towards more sustainable diets.

Many public health authorities and governments use WHO recommendations as a basis to guide decision making. The outlined workstreams indicate WHO’s interest in nutrient profiling, processed foods and beverages, digital marketing and sustainable food systems. Below are some details on individual workstreams:

  • Food profiling model for healthy and sustainable diets

Current food profiling tools (that score foods on nutritional and environmental factors) will be reviewed and used to develop a new standardised tool. This tool will then be used to inform the creation of sustainable food labelling.

  • Data platform for modelling healthy and sustainable dietary patterns

An open-access data platform that will allow governments to assess their national dietary intake data and model diets to meet local nutrition needs and sustainability goals.

  • Guidelines on ultra-processed plant-based foods

Investigating the nutritional composition of ultra-processed plant-based foods (such as vegan burgers) sold in retail and restaurants. This will be used to inform guidelines on ultra-processed plant-based food intake.

  • Healthy digital food environments

An online platform, called FoodDB, that compiles nutrition data from online food retailers, with the intent of making healthy online food choices easier.

These projects will have important ramifications for the treatment of sustainable nutrition by European authorities. Quantifying the nutritional composition of novel foods is essential in understanding their benefits and risks. It is to be hoped that this project will extend to consideration of the bioavailability of the nutrients in the novel foods.

The greater availability of nutritional data to researchers and policy-makers should allow for more evidence-based decisions on food policy shifts. However, the challenge of creating food profiling tools that can fully capture the nutritional and environmental aspects of different foods is clear: nutrition and environmental impacts are very broad topics, and unifying data from both of these fields in order to compare different foods directly will not be straightforward.

Moreover, there is a difference between healthy, sustainable diets and a globally sustainable food system. A diet that meets health, nutrition and sustainability goals for an individual may not be feasible for feeding the global population. For example, increasing the production of a certain food that contributes to one individual’s healthy, sustainable diet may result in less sustainable production of that food. It is essential to consider both what is healthy for individuals and what the global food system can sustainably produce for the global population.

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Feed Our Future event to bring science, government and industry together

The Riddet Institute is this week hosting an event to bring together food system stakeholders and decision makers for accessible evidence-based discussion of the key global issues and the local decisions that we need to make.

Sustainably feeding a growing population is a global problem, but also one for New Zealand to consider. Where does our reputation for high quality, premium food products fit in a hungrier world? How can kiwi innovation and ingenuity make a difference to the global future of food?

The event will explore the current conversation of sustainable food, bringing moderation and balance to what is often a debate of extremes. National and international experts in the fields of nutrition, food waste, food systems, life cycle analysis and consumer science will speak on these important issues, with open discussion from the attendees.

This dialogue will inspire our future decisions and put New Zealand at the front of the sustainable food systems debate.

Dairy in a low-cholesterol diet

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A recent study on dairy’s role in cardiometabolic health has added further nuance to the topic by indicating the different outcomes total dairy and individual dairy products have on biomarkers of disease.

Cardiometabolic diseases including cardiovascular disease, diabetes and chronic renal failure are now the number one cause of death in our aging population. The main cause of these diseases is an unhealthy lifestyle. A broad range of biomarkers (indicators of a disease that can be found in the blood) have been identified and can be used to determine onset. Some studies have linked dairy intake with increased risk of individuals developing cardiometabolic disease. The present study tested these associations to further understand how dairy products can influence cardiometabolic health by measuring biomarkers.

The cross-sectional study included over 35,000 women aged 50 to 79, spanning 40 clinical centres across the US. Concentrations of 20 different biomarkers were compared.

The key findings were:

  • Lower triglyceride (type of fat associated with cardiometabolic disease) was associated with greater intake of total dairy. This was driven by full-fat dairy products
  • Greater total milk and yoghurt intake were associated with lower concentrations of total cholesterol, while greater butter intake was associated with higher cholesterol concentrations
  • Greater total dairy, total and full-fat cheese and yoghurt were consistently associated with lower concentrations of glucose, insulin and C-reactive protein (all of which are biomarkers of cardiometabolic disease).

These findings do not support conclusions of dairy playing a role in cardiometabolic disease, and more specifically the health benefit for low-fat dairy product varieties over full-fat, as promulgated by some health authorities. The challenge in finding consistent outcomes for the role of dairy in the onset of cardiometabolic disease calls for further research in the area. What has been made obvious is the critical role that nutrition plays in the health of our populations and that individual products, rather than food groups, should be considered.

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Increasing the nutritional and environmental benefits of crops

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An integrated technique has been used to find the multiple benefits of introducing legumes to crop rotations in a recent Frontiers study. Not only are these promising findings for developing sustainable food systems, but also a step forward in holistic life cycle analysis measurement.

Adding legumes (beans, peas, lentils) to crop rotations has been shown to increase the nutritional value for livestock and humans while reducing environmental impacts and resource costs. In one example, introducing a legume crop into a typical rotation in Scotland reduced external nitrogen requirements by almost half, with no detriment to the crop’s human nutrient output.

The benefits of legumes range from environmental to nutritional. Unlike many other crops that require additional nitrogen to grow, legumes obtain sufficient nitrogen from the air around them without the need for additional fertilizers. This occurs through a symbiotic relationship with root bacteria that transforms nitrogen in the air to a useable form for plants. Legumes also reduce the need for fertiliser in future crops as they enrich the soil with nitrogen. In terms of human nutrition, legumes are rich in protein, fibre, folates, iron, potassium, magnesium and vitamins.

The novelty of this study was in its comprehensive comparisons across ten crop sequences, 16 impact categories, lengthy timeframes and various European locations. The authors went beyond simple footprinting techniques that only consider the environment or nutrition in isolation. Instead, they considered the footprint of delivering a specific quantity of nutrition. This provides a welcome and realistic perspective on the value of the whole system, with inter-crop effects and overall efficiency of cropping sequences considered.

This work has shown that the choice of functional unit has an important influence on the apparent efficiency of different crop rotations. It also indicates a need for further research using functional units that represent the multiple nutritional attributes of crops for livestock feed. The results of this study illustrate the benefit of using whole-system thinking when designing interventions to drive sustainable food systems.

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Your health is what you eat: the role of nutrition in health

This Thought for Food from Professor and researcher in Health Economics at the University of Sao Paulo, Flavia Mori Sarti, focuses on the importance of healthy diets based on regular intake of fruit and vegetables to maintain health and prevent the onset of noncommunicable diseases (NCDs), alongside the potential impacts on health care costs.

In recent decades, advances in nutrition research have been showing the role of diet in promoting health and preventing diseases. A balanced food consumption pattern that includes diverse types of staples, fruits, vegetables, and protein sources provides the energy, macro- and micronutrients to support healthy lifestyles. The consumption of other bioactive compounds may also help prevent certain chronic NCDs such as type 2 diabetes, dyslipidemias, and cardiovascular diseases.

However, the food consumption patterns of many populations around the world have been changing away from more traditional patterns towards modern diets marked by excessive intake of industrialized foods with high content of sugar, trans-fats and salt. The nutrition transition refers to the process of substitution of foods in natura with industrialized foods in different populations. This is often accompanied by a decrease in physical activities during transport, work and leisure, and an increase in sedentary activities.

The importance of consuming fruits and vegetables

Agriculture remains one of the most important economic activities, generating employment and income for billions of individuals worldwide. There are approximately 250,000 edible plant species known; however, only around 120 species are cultivated for human consumption. In addition, 12 plants and five animal species are responsible for approximately 75% of world food. Yet, plant food sources represent the main source of energy and nutrients, and are the sole contributors to fiber intake in the human diet.

Many health authorities recommend food consumption patterns with increased consumption of fresh fruits and vegetables to ensure sufficient intake of fiber, micronutrients, trace elements and bioactive compounds, also known as phytochemicals.

Dietary guidelines referring to the daily intake of fresh fruits and vegetables seek to promote the supply of nutrients through healthy diets, optimizing body functions and maintaining an individual’s health. Considering variations in cultural habits, several countries and regions publish and update national dietary guidelines based on current nutrition knowledge adapted for their populations (for example, Australia, Brazil, European Union, India, Japan, New Zealand, and the United States).

Nutritional deficiencies, such as a lack of specific vitamins and minerals found at high concentrations in plants, may be prevented through inclusion of diverse fruits and vegetables in daily meals. There is significant evidence that the high consumption of fiber reduces cholesterol and reduces the risk of cardiovascular diseases, diabetes and certain types of cancer. In addition, research on the numerous bioactive compounds that have been identified in plant foods show their contribution to the reduction of risk of NCDs in diverse population groups.

However, not all fruits and vegetables are of equal benefit. The 5-a-day mantra, adopted by authorities in many countries to increase fruit and vegetable consumption, can give the impression that all forms of fruit and vegetables deliver equally positive health consequences. While increased fruit and vegetable consumption is linked to multiple positive health outcomes, it is important to acknowledge the varied nutritional contents of these foods.

For example, there has been much debate on whether fruit juices should count towards achieving intake targets. While fruit juices contain many important micronutrients, they are also a source of sugar while lacking fiber. In developed nations, dietary fruit and vegetable variety is poor, with starchy vegetables making a disproportionately high contribution to vegetable intakes. These foods deliver a high energy intake with low nutrient diversity compared to other vegetables, such as leafy greens. The most desirable increases in fruit and vegetable consumption would be those that deliver high concentrations of micronutrients and fiber without contributing to macronutrient excesses.

Diet-health nexus for reduction of health care costs

Although there is substantial evidence on the protective effects of healthy diets, the consumption of diverse fruits and vegetables in daily diets is usually lower than recommendations in many countries.

The World Health Organization recommendation regarding consumption of fruits and vegetables is to include at least 400 grams per capita per day in the diet. However, according to data from the Food and Agriculture Organization (FAO), only 101 out of 174 countries had sufficient food supply to achieve this recommendation in 2018. Accounting for food waste (approximately 15% to 30% of food supply, depending on the country), the proportion of countries that fulfill the WHO recommendation reduces to approximately 60 out of 174 countries.

On the other hand, 169 out of 174 countries had a food energy supply greater than 2,000 calories per capita per day. Even accounting for food waste, approximately 120 countries still provide excess daily calories for adult individuals with sedentary lifestyles.

Therefore, modern lifestyles lead to a higher prevalence of obesity and related morbidities in many countries. The recent Global Burden of Disease Study 2019 indicated the greatest recorded increase in populations’ exposure to obesity and diabetes was between 1990 and 2019, among other risk factors for early mortality linked with modifiable behaviors. Simultaneously, the low diversity in food consumption patterns provide low intakes of micronutrients and bioactive compounds, characterizing the double burden of diseases, marked by coexistence of undernutrition and obesity related to NCD.

In Brazil, direct costs due to outpatient and inpatient care for treatment of 14 overweight- and obesity-related diseases has been estimated to total US$ 2.1 billion per year between 2008 and 2010. Other estimates pointed to expenditures of approximately 3.45 billion reais (US$ 908 million), attributable to outpatient, inpatient and medication for treatment of hypertension, diabetes and obesity on the national health system in 2018.

A systematic review of literature showed estimates of substantial direct health care costs of obesity and related diseases in 17 studies from developed countries and 6 studies from developing countries. They found that the medical costs associated with obesity and its knock-on effects had been increasing across both the developed and developing world. A previous review indicated that obesity was responsible for approximately 0.7% to 2.8% national health care expenditures in developed and developing countries worldwide. Additionally, individuals diagnosed with obesity usually presented costs 30% higher in comparison with healthy weight individuals due to occurrence of obesity-related NCD.

Conclusion

The reversion of negative nutrition transition trends worldwide depends on changes at individual, social, and policy level: these include gradual modifications of dietary patterns towards greater inclusion of nutrient-dense fruits and vegetables; increased physical activity levels, particularly during transportation and leisure; regulation of food marketing directed at children; adoption of nutrition education strategies; and health promotion actions within primary health care.

The cost-effectiveness of numerous strategies targeting obesity among children, adolescents and adults was assessed through economic evaluation studies in Australia, showing higher effectiveness of actions focusing on lifestyle changes among younger individuals, especially tackling consumption of industrialized foods and beverages, promoting physical activity and encouraging regular consumption of nutritious foods. Primary health care strategies addressing healthy lifestyles through family-based visits and surgical interventions showed reasonable cost-effectiveness.

Besides reducing costs in national health systems, incremental changes in diet associated with adjustments in physical activity level may prevent the onset of diverse NCD and reduce early mortality in different population groups worldwide, thus prolonging healthy life years and maintaining quality of life of individuals. In sum, following dietary guidelines will be a win-win situation for individuals and governments.

The Thought for Food was written by Flavia Mori Sarti, professor and researcher in Health Economics from the University of Sao Paulo, Brazil.

Glossary

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DELTA Model version 1.3 launched

The coloured bar shows the global average availability of each nutrient. The error bars show the range in availability in different parts of the world (10th and 90th population percentiles based on country level averages). While there are only a couple of nutrients where global availability is below target, the level of variation results in many more nutrients of concern at a country level.

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The latest version of the DELTA Model is now available online. It features new insights into national and regional nutrient availability, as well as nutrient trade.

It’s common to talk about food trade between countries or regions, but less common to think about the movement of individual food nutrients around the world. For example, New Zealanders are probably very aware of our country’s exports of animal-sourced foods (like dairy and red meat), but likely haven’t thought about what this means in terms of the calcium or iron included in these exports.

DELTA 1.3 presents the domestic production of 29 food nutrients, the export and import dynamics of these nutrients, and how this measures up to meeting per capita per day nutrient targets for a country. It also presents how this availability differs in different parts of the world, showing the user the inequalities in access to different nutrients. The results are adjusted for waste, non-food uses and bioavailability in the same way as the rest of the DELTA calculations.

Another change is to the splash page first displayed to the user. This now features an outline of the global nutrition challenge that the world is facing, as well as a description of how the DELTA Model was designed to contribute to our understanding of this complex challenge. Further additions and changes can be found in the release notes.

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Could this be the end to ‘dairy-free’ or ‘creamy’ plant-based food in the EU?

The Dairy Ban or ‘Amendment 171’, saw a narrow majority vote by the European Parliament in October 2020, preventing imitation of dairy products by non-dairy products.

This result saw a rally of 21 campaign groups, climate activists such as Greta Thunberg, and large dairy-alternative food producers such as Oatly protest the amendment. A petition against Amendment 171 created by ProVeg has received over 400,000 signatures. Further discussion on the amendment between Council, the Commission and the EU Parliament will continue this year.

Currently dairy terms in the EU are protected by law to ensure integrity of dairy products and to reduce misleading claims by non-dairy products. “Imitation or evocation” of existing dairy products is banned, including terms such as “almond milk” or “vegan cheese”. Amendment 171 furthers this to censor all use of dairy-related language, packaging and imaging in the marketing of plant-based foods. This would see dairy-alternative food producers banned from using terms such as “yoghurt-style”, “creamy”, or packaging that resembles the traditional milk carton and yoghurt pot shapes.

A recent study published in the Journal of Animal and Environmental Law found no difference in consumer perception of products coming from animals, or not, when branding incorporates wording traditionally associated with animal products, e.g. “milk”. Furthermore, omitting these words can lead to confusion from the consumer on taste and use of the product. However, a nutritional aspect was not included in the study, which could provide interesting results in the consumers perception of the product’s nutritional benefit.

Whether the dairy industry secures exclusive rights to the use of dairy-related language or not, this discussion comes down to the consumer. At the heart of both arguments is the push for consumer awareness. Further awareness will allow consumers to make informed decisions on the products they are purchasing and the impact these have on the environment and their health. All of which feeds into the sustainability of us as individuals, communities and globally.

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Trends in food security research

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A recent review of food security research, published in the scientific journal Land, highlights the growth of this field over the last 30 years, as well as the key global regions and topics that have been addressed.

Food security, the ability of people to reliably access sufficient food for a healthy life, is by no means guaranteed in all global regions. Disruptions to parts of the food system, such as natural disasters, climate change or disease outbreaks, are challenges to ensuring adequate food supply and nutrition to affected areas.

Surveying the existing scientific literature on food security, this review article found a dramatic increase in the number of publications since 2013. These publications were predominantly from developed European and North American nations, whereas the research focus was more often on developing areas of Asia and sub-Saharan Africa. Importantly, many developing countries in these regions have not produced research on food security, indicating a lack of research capacity where it is needed most.

The research directions encompassed by this review are diverse, from agriculture, environment and water through to food science, nutrition and public health. Article keywords often linked to food security include climate change, poverty and gender. Trends in food security research topics could be clearly identified over time.

Looking to the future, the authors recommend prioritisation of an interconnected and holistic view of food security. A complete view of the food system is needed to fully understand individual aspects within it.

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Dietary Guidelines for Americans 2020 – 2025 published

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The USDA has released their latest dietary guidelines document, with a new emphasis on the importance of considering different life stages when designing guidelines.

A new set of dietary guidelines are designed for the US population every five years, based on the recommendations of a scientific advisory committee who review the latest nutrition and health research, ensuring up-to-date advice.

In this document, specific dietary recommendations for infants and toddlers appear, where before this advice was absent. These recommendations cover breastfeeding and infant formula use, as well as complementary foods. Strong emphasis is placed on food variety for toddlers, as well as on the importance of iron and zinc intake.

The guidelines recommend that Americans should eat more whole fruits, vegetables, and whole grains, while limiting added sugars and saturated fat to less than 10% of daily calories each. While this largely chimes with the advisory committee’s scientific report, they had suggested that only 6% of daily calories be from added sugar, due to the negative health outcomes of high dietary sugar intake. The committee were also cautious on the contentious subject of saturated fat, not recommending any change to the current guidelines and mentioning that replacement of these fats with carbohydrates is not advised.

Nutrient density and dietary patterns were pulled out as important terms in the report. Nutrient dense foods are recommended throughout, and listed as vegetables, fruits, whole grains, seafood, eggs, beans, peas, lentils, unsalted nuts and seeds, fat-free and low-fat dairy products, and lean meats and poultry. However, the recommendations put emphasis on dietary patterns rather than on individual foods or food groups to enable adaptations that fit cultural, personal and individual needs and preferences. The three food patterns of the guidelines are the Healthy U.S-Style Pattern, the Healthy Vegetarian Pattern and the Healthy Mediterranean-Style Pattern. All three patterns provide most of their energy from plant-based sources, provide protein and fat from nutrient rich sources and limit intakes of added sugars, solid fats and sodium.

This is consistent with the results of the DELTA Model which illustrates that most of our energy should come from nutrient rich foods to ensure all nutrient requirements are met. Nutrient poor foods such as sugar should be minimised, and it is essential to consider the different needs of different demographic groups.

Interestingly, the guidelines make no mention of the environmental sustainability of different foods or diets. Several countries already make this inclusion, with this number likely to increase, but it will be at least 2025 before any such recommendations appear in the US dietary guidelines.

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WWF encourage planet-based diet

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The WWF report Bending the Curve: The Restorative Power of Planet-Based Diets joins other efforts to demonstrate the negative health and environmental consequences of our current way of producing and consuming food, while proposing ways to turn this around.

The report opens with the assertion that our food system must provide healthy, safe, affordable and nutritious diets for all, with reference to the UN Food Systems Summit later this year and the Sustainable Development Goals. This is completely in line with the principles of SNI: nutrition must come first when considering the global food system. The report then goes on to define planet-based diets as win-wins: healthy and with low environmental impacts and explores how these can be achieved.

A major recommendation of the report is that national dietary guidelines need to be more ambitious. This echoes a results of a previous WWF model. Currently, these guidelines largely reflect a healthier version of current consumption patterns and do not consider environmental impacts. The report argues that guidelines could be simultaneously healthier and more sustainable.

The main health recommendation of the report is to increase the plant-based proportion of the diet and decrease overconsumption. This is supported by the Global Burden of Disease study findings, indicating that low wholegrain and fruit intake, as well as high sodium intake, were the greatest dietary risk factors.

Beyond these overarching directions, recommendations for dietary and production change vary on a regional level. This is due to the difference in dietary, health and environmental factors seen in different parts of the world.

Countering biodiversity loss also requires a nuanced approach. For example, the report finds that most of the biodiversity loss associated with the Danish diet is due to imports of coffee, tea, cocoa and spices. Contrastingly, red meat holds this place for Latin American countries.

Similarly, the report states that we must feed our population on existing agricultural land and not further expand, but again the implications vary by region. Countries suffering from widespread undernutrition may need to expand their agricultural land to ensure healthy diets for their population, while more developed countries may need to contract.

The same regional variability is true for the planting of trees for carbon sequestration, conversion of grazing land to arable or optimising water use. The results of the report emphasise careful consideration of actions at a national level, as healthier diets can lead to increased environmental damage of one kind or another in vulnerable regions. A one-size-fits-all approach will not lead to a sustainable food system.

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