Sustainable Diets as Tools to Harmonize the Health of Individuals, Communities and the Planet: A Systematic Review
2. Materials and Methods
2.1. Search Strategy
2.2. Extraction of Information
4. Synthesis and Discussion
4.1. Determining the Weight of Food Types in Environmental Impact
- The GHG footprint is higher for beef and lamb (~30 gCO2eq/g), pork (~3 gCO2eq/g), eggs, milk, rice and palm oil (~1–2 gCO2eq/g).
- The freshwater footprint is higher for animal-sourced products, sugar, legumes and rice (0.5–1 m3/kg).
- The cropland use is high for legumes, vegetable oils and oil crops, nuts and seeds and animal-sourced products (5–11 m2/kg).
- The nitrogen footprint is high for animal-sourced products, cereals (wheat, rice, maize), oil crops, nuts and seeds and fruits and vegetables (10–50 kg N/kg).
4.2. Sustainable Diet and Health-Environment Co-Benefits
4.3. Strategies to Promote Sustainable Diets
4.3.1. Identification of Sustainable Dietary Patterns
4.3.2. Promotion in Clinical Practice and at the School Environment
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Main Findings Related with Nutrition/Health Impact||Main Findings Related with Environmental Impact||Promotion|
|Benedetti et al., 2018 ||Italy||Modelling|
(secondary data: Aspect of Daily Life, survey).
|From 1997 to 2012:|
Daily consumption of pasta, rice and bread decreased from 42.28% to 29.37%.
Consumption of red meat fluctuated and then dropped slightly while the consumption of pork meat increased. Eggs, fruit, vegetables and dairy product consumption increased slightly.
|Gender (men), age (young) and presence of children in the family had a negative influence in adherence to MD as sustainable eating pattern.|
Being employed and having a higher educative level were strong predictors of MD adherence.
These social factors must be taken into account to address the promotion of sustainable diets.
|Black et al., 2015 ||Canada |
(directed observation, key informants interviews).
|Environmentally sustainable foods are those minimally processed, locally grown/sourced, organic, seasonal, with less/minimal packaging and vegetarian options||They show that policies and programs to promote sustainable diets are not well implemented in schools and identify the general absence of proposals for healthy and sustainable food options in schools, despite the fact that most included sustainability through gardening and compost activities. However, there were still vending machines with processed and sugary foods and beverages.|
|Blas et al., 2019 ||Spain||Modelling|
(secondary data Governmental datasets about food consumption, production, importations and exportations).
|Spain abandons MD for a more caloric, meat and fat diet and with fewer fruits and vegetables, which inevitably affects the health of the population.||This type of diet is less efficient at the water level, so returning to MD would reduce water consumption by about 750 L/person per day and improve water-nutritional efficiency by providing more energy, fiber and nutrients per liter of drinking water.||It is advisable to promote a return to the traditional dietary pattern of the Mediterranean diet.|
|Brink et al., 2019 ||Netherland||Modelling|
(secondary data offered by Health Council of the Netherlands: national consumption data, National dietary guidelines and dietary reference valued, constraints associated to food groups).
|A consumption pattern in line with these guidelines reduces the risk of major chronic diseases and supplies adequate amounts of energy and nutrients.|
The transition from the current dietary pattern to a sustainable one requires a higher consumption of vegetables, fruits, wholegrain foods, nuts, fish and legumes. A reduction in meat consumption to 500 g per week instead of the current 930 g in men and 615 g in women.
|The transition from the current dietary pattern to a sustainable one reduces GHGE by up to 13% for men aged 31–50 years, whereas they increase slightly by 2–5% for women. These results could be improved with a further reduction in meat and replacing it by nuts, legumes and eggs.||Therefore, sustainable diets are also subject to personalized recommendations based on demographic characteristics (age and sex)|
|Chen et al., 2019 ||Global||Modelling|
(secondary data from FAO food balance sheet. Healthy global diet and food greenhouse gas tax diet were designed in a previous study).
|They model the environmental, nutritional, economic and health effects of the transition from the current Swiss diet to nine possible eating patterns (current Swiss diet, Healthy Global Diet, diet of Swiss Society in Nutrition, vegan diet, lacto-ovo vegetarian, lacto-ovo pescatarian, flexitarian, protein-oriented diet, meat-oriented diet and food greenhouse gas tax diet.|
The transition from the current diet to the diet recommended by the guide of the Swiss Nutrition Society is the most optimal as it would reduce the environmental footprint by 36% and the DALYs by 2.67%
|Environmental impact associated with diets was measured (GHGe and freshwater footprints, cropland use and, nitrogen and phosphorous footprints): GHGe was the highest with beef and lamb, followed by pork, eggs, milk, rice and palm oil. Freshwater footprint was high for animal-sourced products, sugar, legumes and rice. Cropland use was high for legumes, vegetable oils, nuts and seeds and animal-sourced products. Nitrogen and phosphorus footprints were highest for animal-sourced products, cereals (wheat, rice, maize), oil crops, nuts and seeds and fruits and vegetables.|
|Cobiac et al., 2019 ||England, France, |
Scenarios: (1) according nutrition recommendations (NR), (2) diet according NR/without GHGe increased, (3) diets according NR/GHGe reduced in 10%, and (4) diet with GHGe minimised.
|Sustainable diets substantially improve the health of the population and consequently life expectancy would increase between 2.3 and 6.8 months per country. Simultaneous reduction of GHGe does not reduce the effect size, and in some cases produces additional health benefits.||Diet reduced in GHGe are those with large reductions in consumption of red and processed meats, salt and fats, and increases in fruits and vegetables and fiber.|
|de Boer et al., 2014 ||Netherland|
|On average, the meat consumption was 5.4 days/week with portions from 50 to more than 150 g. A statistical association is shown (with small values of r and R2) between meat consumption patterns (frequency, portion size), search for substitutes and sociodemographic variables.||However, taking into account the cultural aspect of the Dutch diet it was concluded that it is better to promote the consumption of good quality meat in small portions and recommended frequency than the total abandonment of it and that the true efficiency of a sustainable diet must be based on its total composition and not just on one type of food.|
|Donati et al., 2016 ||Italy|
(survey, 7 days’ dietary records. European Institute of Oncology database and Barilla Center for Food and Nutrition’s database)).
|The observed diet was rich in meat, but very poor in fruits and vegetables and the main sources of energy are bread and substitutes (28%), pasta and rice (20%), sweets (19%) and meat (13%). It was optimized according 3 objectives resulting:|
Minimum Cost Diet, Environmentally Sustainable Diet (CO2e, H2O consumption and amount of soil and water to regenerate the resources) and Sustainable Diet (integrates both previous).
|The environmental impact was evaluated for a period of 7 days per person taking into account both quantities and frequency of|
consumption for the different food items. A diet which eliminates meat consumption by substituting legumes involved a reduction of CO2e by 50%.
The sustainable diet model, may lead to a 51% cut in CO2e emissions, 9% reduction in H2O consumption and 26% less land needed to regenerate the resources compared to the current diet.
|Fresán et al., 2018 ||Spain|
(7-d record with a semi-quantitative FFQ (136 food items), nine-item MD index).
|Participants with better adherence to MD had higher energy and non-fat/low-fat dairy intake. They consumed more fish and seafood, vegetables, fruits, legumes, cereals and beverages (especially water, red wine and other alcoholic beverage, but less sugar-sweetened sodas). However, the consumption of pastries,|
eggs and meat (any kind) was lower.
|To assess the environmental impact, it took into account the production and processing only and just conventional agriculture processes. The category of “meat and eggs” was the one that caused the greatest environmental impact.|
MD involved lower land use (−0.71 (95% CI −0.76, −0.66) m2/d), water consumption (−58.88 (95% CI −90.12,
−27.64) litres/d), energy consumption (−0.86 (95% CI −1.01, −0.70) MJ/d) and GHG emission (−0.73 (95% CI −0.78, −0.69) kg CO2e/d).
|The promotion of the Mediterranean diet pattern is an ecofriendly and healthy option that could efficiently help prevent chronic diseases while reducing the environmental impact derived from food production.|
|Hendrie et al., 2016 ||Australia||Modelling|
(2011–2013 Australian Health Survey data on food consumption, household expenditure data, National GHG Inventory).
|They modelled the GHGe from 3 current eating patterns: (1) higher nutritional quality and lower GHGe, (2) lower nutritional quality and higher (3) The average existing Australian adults’ intake (4) eating pattern recommended by Australian Guide to Healthy Eating.||The GHGe associated with food were estimated using environmentally|
extended input–output analysis. There is a significant positive correlation between total energy and amount of food consumed (total food in grams) with total dietary GHGe.
Fruits and vegetables were the two
smallest contributors to total dietary GHGe (3.5 and 6.5% respectively), and fresh and processed meat and alternatives (33.9%) were the highest contributors (where red meat contributed 17.6% and chicken 11%)
|Kramer et al., 2017 ||Netherland||Modelling|
(Dutch National Food Consumption Survey 2007–2010).
|Analyzing the Dutch diet divided into 4 segments according to sex and age, it was found that all had partial nutrient deficiencies (α-linoleic acid, dietary fiber, EPA and DHA, Fe intakes were too low for one or more groups)||GHGe, fossil energy use and land occupation were used to calculate a weighted score for the overall environmental impact of food products. The model predicts a decreased overall environmental impact when a reduction of meat consumption is applied and in bread, fatty fish and legumes are increased. Eliminating fish and dairy products did not appear to be an effective option, while consumers can substantially reduce the environmental impact of their diet by drinking fewer alcoholic and non-alcoholic beverages.|
|Masset et al., 2014 ||France|
(7-d record from French Agency
for Food, Environmental and Occupational Health Safety, 2006 Kantar-World Panel purchase database and PANDiet index).
|Higher-Quality diets were defined as those with a PANDiet score higher than the sex specific median score.|
Around 20% of adults had sustainable diets which combined a higher nutritional quality and lower GHGE
without increasing the cost.
|GHGe values provided by an external consulting firm (Greennext Service) following LCA analysis. Lower-Carbon diets were defined as those with a total diet related GHGE lower than the sex-specific median value.|
More sustainable diets were those with reduced energy intake and reduced energy density, containing the highest content of plant-based foods, particularly starchy foods. In addition, foods of animal origin and alcoholic beverage consumption was highly associated with dietary GHGe.
Introducing these changes to the model meant that approximately one fifth of French adults achieved a sustainable diet with better nutritional quality and GHGe decreased by almost 20% at no additional cost compared to the population average.
|Oita et al., 2018 ||Japan||Modelling|
|From 1961 to 2011, the per capita consumption of protein of animal origin has increased in Japan||In parallel with the protein consumption increased, the nitrogen footprint derived from food has increased a 55%.||It is recommended to return to a traditional Japanese diet for its demonstrated link with the delay of senescence and lower traces of nitrogen than the current one.|
|Sáez-Almendros et al., 2013 ||Spain|
(6000 households, 840
and 230 institutions)
(secondary data: FAO food balance sheets for 2007, Household Consumption Surveys of the Spanish Ministry
of Agriculture, Food and Environment, MD pattern pyramid).
|The Mediterranean diet pattern proposed by the Group of Experts of the Mediterranean Diet Foundation (MDP), the current Spanish consumption pattern (SCP) and western consumption based on the US consumption pattern (WDP) are compared.||For GHG emissions, land use, water and energy consumption, MDP < SCP < WDP was always observed.|
Greater adherence to MD in Spain would reduce GHG emissions (72%), land use (58%), energy consumption (52%), and water consumption (33%).
|Sobhani et al., 2019 ||Iran|
(secondary data: semi-quantitative 168-item food frequency questionnaire, Food-Based Dietary Guidelines for Iran).
|From a sustainable diet approach, the water footprint derived from the observed real diet and three hypothetical scenarios are analyzed: (A) usual ingested energy, (B) A + serving recommended in the nutritional pyramid and (C) B + nutrients recommended in RDA. Water consumption was A < C < B < actual diet.||The decrease in water consumption was mainly linked to the decrease in food of animal origin. Scenario A was deficient in micronutrients with respect to the real diet. Nor does B by itself ensure an adequate supply of micronutrients. Scenario C appears to be optimal|
|Springman et al., 2016 ||Global||Modelling|
(International Model for Policy Analysis of Agricultural
Commodities and Trade, food availability data from the FAO and WHO data on mean BMI).
|Diets based mainly on plant foods suppose a healthier eating pattern associated with a greater reduction in available food of 3.2% per person that would suppose more than half a million deaths in the world, mainly related to the decrease in fruit consumption and vegetables.|
|Springman et al., 2018 ||150 countries||Modelling.||Analysis was carried out focusing on 3 objectives: i) Environmental (25–100% of origin animal foods substituted for vegetables) led to a 12% reduction in premature mortality and a 86% reduction in GHG emissions, mainly in high-income countries; ii) food security (25–100% reduction in underweight, overweight and obesity) reduced premature mortality by around 10% and improved nutrient availability, although with little improvement in environmental impact; iii) public health, evaluating the flexitarian, pescatarian, vegetarian and vegan patterns that all showed to be healthy and reduced mortality between 12 and 22%, also reducing the environmental impact.||Reduction of GHEe was mainly mediated by reducing of meat consumption in diets designed for objectives i) Environmental and ii) Public Health.|
The lower environmental impact reduction measured by others indicators (cropland, nitrogen and phosphorus) was obtained with diets of environmental objective which involved, moreover, a higher water consumption.
|The promotion of sustainable diets must take into account the local socio-economic development, since differences were observed in the results according to the different regions of the planet.|
|Temme et al., 2015 ||The Netherlands(3818)||Transversal|
(Dutch National Food Consumption Survey 2007–2010, Dutch food composition database, Short Questionnaire to Asses Health enhancing physical activity).
|The food consumption was measured on two non-consecutive days, by means of a 24 h dietary recall excluding pregnant and lactating women, institutionalized people and those with language barriers.|
The average total quantity of foods and drinks consumed was 2.2 (SD 0.6) kg/d, 2.5 (SD 0.8) kg/d, 3.1 (SD 0.9) kg/d and 3.4 (SD 1.0) kg/d for girls, boys, women and men, respectively. Of this, 0.9–1.1 kg/d was from foods and the remaining weight was from drinks.
|GHGe values provided by an external consulting firm (Blonk Consultant) following LCA analysis.|
The habitual GHGE of a day’s consumption in the Netherlands was on average 3.2 kg CO2e for girls, 3.6 kg CO2e for boys, 3.7 kg CO2e for women and 4.8 kg CO2e for men. About 40% of the GHGe of daily diets stemmed from meat and cheese, with a similar percentage in girls, boys, women and men. Drinks (including milk and alcoholic drinks) involved 20% to daily GHGe
|Sustainable diets are also subject to personalized recommendations based on demographic characteristics (age and sex)|
|Van de Kamp, et al., 2018a ||Netherland |
(Dutch National Food Consumption Survey, Dutch Food Composition Table (NEVO-Table 2011/3.0), Short Questionnaire
to Assess Health enhancing physical activity).
|Four scenarios were tested:|
(1) red/processed meat reduction during dinner by 50–75% (meat was reduced with 85 g/day for men and 59 g/day for women);
(2) 50–100% of alcoholic and soft drinks replaced by water;
(3) cheese consumed in between meals replaced by plant-based alternatives;
(4) two combinations of these scenarios.
The different scenarios were compared with diet observed from National surveys which was taken as reference.
|GHGe values provided by an external consulting firm (Blonk Consultant).|
Subjects were stratified by gender and dietary GHG emissions. Scenarios 1 and 2 involved a 15–34% reduction of dietary GHG emissions linked to a reduced saturated fatty acid intake and/or sugar intake, reduced energy and iron intakes and adequate protein intake (for both sex).
When snacking on cheese was replaced by plant-based substitutes, as well as the replacement of 50–100% of soft/alcoholic drinks by water, a reduction in GHGe by < 10% was observed.
|Van de Kamp, et al., 2018b ||Netherland|
(2106 only for current diet)
(secondary data: Dutch National Food Consumption Survey, Dutch Food Composition Table, Wheel of five).
|They analyse 3 scenarios: (1) the current Dutch diet (diet observed from National surveys), (2) its version adapted to national recommendations (Wheel of 5) and (3) this same adaptation, but only including foods with relatively low GHG emissions.Consumption of red meat is lower in scenarios 2 and 3, but fish consumption was similar in all scenarios. Consumption of most other food groups in the Wheel of Five is lower in the current diet than scenarios 2 and 3.||Scenario 2 involved a GHGe change by −13% for men aged 31–50 years and +5%|
for women aged 19–30 years. Scenario 3 involved a GHGe reduction from 28 to 46%.
It is shown that the current diet is not the most sustainable and that its mere adaptation to the recommendations may not be enough for it to also be sustainable. It is necessary to make an effort to choose foods with low GHG emissions to achieve the health–environment co-benefits
|Wilson et al., 2013 ||New Zealand (16)||Modelling.||Current New Zealand dietary pattern is relatively expensive and unhealthy, with high saturated fat and sodium intakes.|
Scenarios compared were grouped in: (1) low-cost; (2) low in GHGe and low-cost; (3) ‘‘relatively healthy diets’’ with high vegetable intakes according to Mediterranean/Asian style diets and an Asian, but with cost and GHG constraints; and (4) that included ‘‘more familiar meals’’, potentially more acceptable to New Zealanders.
All scenarios showed be healthier than current diet. Scenario 2 had health advantages over the current dietary pattern due to higher vegetable content and less sodium and saturated fat. Optimized diets improved stroke prevention associated with higher presence of polyunsaturated fatty acid vs. saturated fat from meat, lower sodium intake and higher potassium intake. Plant-rich diets also provided benefits against colorectal cancer due to their higher fiber content
|The lowest CO2 emissions were those derived from Scenario 2 which ranged from 1.31 to 1.9 kg of CO2 equivalents per person per day. Scenario 1 was associated with outputs of 2.20 to 4.33 kg of CO2 equivalents per person per day. Scenarios 1 and 2 were generally complementary, but a trade-off between increased daily food cost and consuming food associated with lower GHGe was observed due to the reduction in higher GHG foods (i.e, eggs and milk) induce the selection of more expensive alternative foods.|
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Kowalsky, T.O.; Morilla Romero de la Osa, R.; Cerrillo, I. Sustainable Diets as Tools to Harmonize the Health of Individuals, Communities and the Planet: A Systematic Review. Nutrients 2022, 14, 928. https://doi.org/10.3390/nu14050928
Kowalsky TO, Morilla Romero de la Osa R, Cerrillo I. Sustainable Diets as Tools to Harmonize the Health of Individuals, Communities and the Planet: A Systematic Review. Nutrients. 2022; 14(5):928. https://doi.org/10.3390/nu14050928Chicago/Turabian Style
Kowalsky, Tatianna Oliva, Rubén Morilla Romero de la Osa, and Isabel Cerrillo. 2022. "Sustainable Diets as Tools to Harmonize the Health of Individuals, Communities and the Planet: A Systematic Review" Nutrients 14, no. 5: 928. https://doi.org/10.3390/nu14050928