Balancing a sustained pursuit of nutrition, health, affordability and climate goals: exploring the case of Indonesia.

To guide the transformation of food systems to provide for healthy and sustainable diets, countries need to assess their current diet and food supply in comparison to nutrition, health, affordability, and environmental goals. We sought to compare Indonesia's food utilization to diets optimized for nutritional value and cost and to diets that are increasingly plant-based in order to meet further health and environmental goals, including the EAT-Lancet planetary health diet, to explore whether multiple goals could be achieved simultaneously. We compared 13 dietary scenarios (2 current, 7 optimized, 3 increasingly plant-based, 1 EAT-Lancet) for nutrient content, cost, greenhouse gas emissions (GHGe), and water footprints, using the FAO food balance sheet, Indonesia Household Income and Expenditure Survey household food expenditure, food composition, life cycle assessment, food losses, and trade data. The diversity of modeled scenarios was higher than that of current consumption, reflecting nutritional deficiencies underlying Indonesia's burden of different forms of malnutrition. Nutrient intake targets were met best by nutrient- and cost-optimized diets, followed by the EAT-Lancet diet. Those diets also had high GHGe, although less than 40% of a scenario in which Indonesia would adopt a typical high-income country's diet. Only the low food chain diet had a GHGe below the 2050 target set by the EAT-Lancet commission. Its nutrient content was comparable to that of a no-dairy diet, slightly above those of fish-and-poultry and current diets, and somewhat below those of the EAT-Lancet diets. To meet nutrient needs, some animal-source foods had to be included. Costs of all except the optimized diets were above the current national average food expenditure. No scenario met all goals simultaneously. Indonesia's consumption of rice and unhealthy foods should decrease; food production, trade, and processing should prioritize diversification, (bio)fortification, and limiting environmental impacts; and consumer and institutional demands for healthy, nutritious, and sustainable foods should be stimulated. More granular data and tools are required to develop and assess more detailed scenarios to achieve multiple goals simultaneously.

de Pee S ，Hardinsyah R ，Jalal F ，Kim BF ，Semba RD ，Deptford A ，Fanzo JC ，Ramsing R ，Nachman KE ，McKenzie S ，Bloem MW ... -  《-》

Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study.

While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets. Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios. We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect. The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns.

Caldeira TCM ，Vandevijvere S ，Swinburn B ，Mackay S ，Claro RM ... -  《Nutrition Journal》

Future-proof and sustainable healthy diets based on current eating patterns in the Netherlands.

To keep global warming <1.5°C as recommended by the Intergovernmental Panel on Climate Change (IPCC), eating patterns must change. However, future diets should be modeled at a national level and respect cultural acceptability. We aimed to identify diets among Dutch adults satisfying nutritional and selected environmental requirements while deviating minimally from the baseline diet among Dutch adults. We calculated per capita food system greenhouse gas emission (GHGE) targets derived from the IPCC 1.5-degree assessment study. Using individual adult dietary intake from the National Food Consumption Survey in the Netherlands (2007-2010) to form a baseline, we used quadratic optimization to generate diets that followed the baseline Dutch diet as closely as possible, while satisfying nutritional goals and remaining below GHGE targets. We considered 12 scenarios in which we varied GHGE targets [2050: 1.11 kg of carbon dioxide equivalent (kg CO2-eq) per person per day (pppd); 2030: 2.04 kg CO2-eq pppd; less strict 2030: 2.5 kg CO2-eq pppd; no target], modeled eating patterns (food-based dietary guidelines; flexitarian; pescatarian; lacto-ovo-vegetarian; vegan), and conducted exploratory analyses (food diversity; acceptability; food chain interdependency). Optimized solutions for 2030 required major decreases (<33% of baseline values) in consumption of beef, pork, cheese, snacks, and butter and increased consumption (>150% of baseline values) of legumes, fish and shellfish, peanuts, tree nuts, vegetables, soy foods, and soy drink. Eight food groups were within 33%-150% of the baseline diet among Dutch adults. The optimized solution complying to the lowest GHGE target (2050) lacked food diversity, and the (lacto-ovo) vegetarian and vegan optimized diets were prone to nutritional inadequacies. Within Dutch eating habits, satisfying optimization constraints required a shift away from beef, cheese, butter, and snacks toward plant-based foods and fish and shellfish, questioning acceptability. Satisfying 2050 food system GHGE targets will require research in consumer preferences and breakthrough innovations in food production and processing.

Broekema R ，Tyszler M ，van 't Veer P ，Kok FJ ，Martin A ，Lluch A ，Blonk HTJ ... -  《-》

Affordability of the EAT-Lancet reference diet: a global analysis.

The EAT-Lancet Commission drew on all available nutritional and environmental evidence to construct the first global benchmark diet capable of sustaining health and protecting the planet, but it did not assess dietary affordability. We used food price and household income data to estimate affordability of EAT-Lancet benchmark diets, as a first step to guiding interventions to improve diets around the world. We obtained retail prices from 2011 for 744 foods in 159 countries, collected under the International Comparison Program. We used these data to identify the most affordable foods to meet EAT-Lancet targets. We compared total diet cost per day to each country's mean per capita household income, calculated the proportion of people for whom the most affordable EAT-Lancet diet exceeds total income, and also measured affordability relative to a least-cost diet that meets essential nutrient requirements. The most affordable EAT-Lancet diets cost a global median of US$2·84 per day (IQR 2·41-3·16) in 2011, of which the largest share was the cost of fruits and vegetables (31·2%), followed by legumes and nuts (18·7%), meat, eggs, and fish (15·2%), and dairy (13·2%). This diet costs a small fraction of average incomes in high-income countries but is not affordable for the world's poor. We estimated that the cost of an EAT-Lancet diet exceeded household per capita income for at least 1·58 billion people. The EAT-Lancet diet is also more expensive than the minimum cost of nutrient adequacy, on average, by a mean factor of 1·60 (IQR 1·41-1·78). Current diets differ greatly from EAT-Lancet targets. Improving diets is affordable in many countries but for many people would require some combination of higher income, nutritional assistance, and lower prices. Data and analysis for the cost of healthier foods are needed to inform both local interventions and systemic changes. Bill & Melinda Gates Foundation.

Hirvonen K ，Bai Y ，Headey D ，Masters WA ... -  《Lancet Global Health》

Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail.

Sustainable diets are intended to address the increasing health and environmental concerns related to food production and consumption. Although many candidates for sustainable diets have emerged, a consistent and joint environmental and health analysis of these diets has not been done at a regional level. Using an integrated health and environmental modelling framework for more than 150 countries, we examined three different approaches to sustainable diets motivated by environmental, food security, and public health objectives. In this global modelling analysis, we combined analyses of nutrient levels, diet-related and weight-related chronic disease mortality, and environmental impacts for more than 150 countries in three sets of diet scenarios. The first set, based on environmental objectives, replaced 25-100% of animal-source foods with plant-based foods. The second set, based on food security objectives, reduced levels of underweight, overweight, and obesity by 25-100%. The third set, based on public health objectives, consisted of four energy-balanced dietary patterns: flexitarian, pescatarian, vegetarian, and vegan. In the nutrient analysis, we calculated nutrient intake and changes in adequacy based on international recommendations and a global dataset of nutrient content and supply. In the health analysis, we estimated changes in mortality using a comparative risk assessment with nine diet and weight-related risk factors. In the environmental analysis, we combined country-specific and food group-specific footprints for greenhouse gas emissions, cropland use, freshwater use, nitrogen application, and phosphorus application to analyse the relationship between the health and environmental impacts of dietary change. Following environmental objectives by replacing animal-source foods with plant-based ones was particularly effective in high-income countries for improving nutrient levels, lowering premature mortality (reduction of up to 12% [95% CI 10-13] with complete replacement), and reducing some environmental impacts, in particular greenhouse gas emissions (reductions of up to 84%). However, it also increased freshwater use (increases of up to 16%) and had little effectiveness in countries with low or moderate consumption of animal-source foods. Following food-security objectives by reducing underweight and overweight led to similar reductions in premature mortality (reduction of up to 10% [95% CI 9-11]), and moderately improved nutrient levels. However, it led to only small reductions in environmental impacts at the global level (all impacts changed by <15%), with reduced impacts in high-income and middle-income countries, and increased resource use in low-income countries. Following public health objectives by adopting energy-balanced, low-meat dietary patterns that are in line with available evidence on healthy eating led to an adequate nutrient supply for most nutrients, and large reductions in premature mortality (reduction of 19% [95% CI 18-20] for the flexitarian diet to 22% [18-24] for the vegan diet). It also markedly reduced environmental impacts globally (reducing greenhouse gas emissions by 54-87%, nitrogen application by 23-25%, phosphorus application by 18-21%, cropland use by 8-11%, and freshwater use by 2-11%) and in most regions, except for some environmental domains (cropland use, freshwater use, and phosphorus application) in low-income countries. Approaches for sustainable diets are context specific and can result in concurrent reductions in environmental and health impacts globally and in most regions, particularly in high-income and middle-income countries, but they can also increase resource use in low-income countries when diets diversify. A public health strategy focused on improving energy balance and dietary changes towards predominantly plant-based diets that are in line with evidence on healthy eating is a suitable approach for sustainable diets. Updating national dietary guidelines to reflect the latest evidence on healthy eating can by itself be important for improving health and reducing environmental impacts and can complement broader and more explicit criteria of sustainability. Wellcome Trust, EAT, CGIAR, and British Heart Foundation.

Springmann M ，Wiebe K ，Mason-D'Croz D ，Sulser TB ，Rayner M ，Scarborough P ... -  《The Lancet Planetary Health》