National Food-based Dietary Guidelines Research Articles

Integrating environmental sustainability within national food-based dietary guidelines: a qualitative analysis from five case study countries

Abstract Background The incorporation of environmental sustainability principles into national food-based dietary guidelines (FBDGs) has gained prominence as a strategy to address both human health and environmental concerns. This study aims to identify and explore the processes and considerations to integrate environmental sustainability in food-based dietary guidelines. Methods Countries that have integrated environmental sustainability in FBDGs since 2016 were identified from the UN FAO website. Background documents and interviews with key stakeholders involved in the development of FBDGs from case study countries (The Netherlands, Denmark, Chile, France and Belgium (Flanders)) were thematically analysed using the Framework Method. A coding framework explored the rationale for integration, data sources and analysis methods, stakeholder and expert engagement, synergies and trade-offs, translation into public messaging, and key learnings. Results Eight background documents and six interviews were analysed. Approaches to integrating environmental sustainability varied, from inclusion in dietary modelling optimisation to changes to consumer messaging. Nearly all countries adjusted guidelines to reduce red and processed meat and emphasise the role of plants in diets. However, issues of cultural significance, affordability, and access limited ambitions to reduce overall meat intake. Novel plant-based alternatives remain contentious due to concerns about their ultra-processed nature and potential nutrient inadequacies as substitution foods. Key barriers to integrating environmental sustainability into FBDGs include consumer acceptance, data quality and availability, stakeholder involvement and conflict, timelines, and resource constraints. Conclusions Several countries have successfully integrated environmental sustainability into their dietary guidelines, but there is still variation in the integration and acceptance of FBDGs including environmental sustainability.

4.F. Scientific session: Progress in assessing climate change risks to health and implementation in UK and Europe

Abstract Climate change poses one of the greatest threats to health security. Climate change is increasing the frequency and intensity of environmental health threats like flooding and heatwaves and is creating conditions which heighten the risks from infectious diseases. Whilst everyone will be at some risk from adverse health impacts from climate change, the impacts will vary at individual level and the most disadvantaged both here in the UK and around the world will be disproportionately affected. Many of the anticipated adverse health impacts of climate change in the UK are still avoidable through mitigation and adaptation and that there are other benefits to health to be gained, therefore rapid action is critical to avoid the most severe potential scenarios. The Health Protection Research Unit in Environmental Change and Health, funded by the National Institute of Health Research, provides multi-disciplinary research to support decision-making relating to the impacts and responses to environmental changes that affect human health and well-being in the UK and beyond. In this workshop we present the results of recent research on the progress in assessing climate change risk factors on health in the UK and review the evidence on implementation of mitigation and adaptation measures in Europe. The workshop aims to support evidence translation for climate action that prioritises health protection and equity. The workshop will include presentations on reviewing risk assessment methods for quantifying health impacts across Europe as well as analysing the effects of fuel poverty on cold-related mortality. We present results from an analysis of primary care data to identify individual level characteristics associated with increased risk of mortality during heatwaves. Furthermore, we review national food-based dietary guidelines across Europe and South America to determine how environmental sustainability is being integrated to benefit health. The workshop will comprise 4 -5 oral presentations and we will then open the floor to have a wider facilitated discussion about what are the evidence needs for UK and European policy to further address climate risks to health. Key messages • The progress in assessment and understanding of risks from climate change on health is improving. • The health risks we face from climate change will not be distributed equally across the UK and Europe.

Integrating environmental sustainability into food-based dietary guidelines in the Nordic countries

The overall aim of this paper was to provide background knowledge to the Nordic Nutrition Recommendations 2023 Committee for integrating environmental sustainability in a framework for national Food-Based Dietary Guidelines (FBDG) within the Nordics and Baltics. Additionally, this paper aims to give an overview of recent Nordic scientific literature on environmental impact of foods and dietary patterns and of the FBDG of the Nordics. Finally, we suggest methods for developing national sustainable FBDG. Nordic and Baltic studies on sustainability of diets were searched in August 2022 and complemented with additional relevant literature. The studies show that current diets are far from environmentally sustainable, exceeding planetary boundaries for most impact categories; meat and dairy products being the largest contributors to dietary greenhouse gas emissions (GHGEs) and land use. Scenario, modelling, optimisation and intervention studies confirm the potential of shifting towards more plant-based diets to improve overall diet quality in terms of both health and environmental sustainability. Such diets comprised of vegetables, fruits, legumes, potatoes, whole grain and refined cereal products, nuts, seeds and vegetable oils, with animal foods in moderate or limited amounts. The FBDG in the Nordics promotes more plant-based diets than the current average diet but could improve from further integration of environmental sustainability. To form basis for sustainable FBDG dietary modelling at the national level, prioritising health outcomes and nutritional adequacy is essential. Second, integrating environmental sustainability involves estimating the impact of food choices and amounts on GHGE, land and water use, eutrophication and biodiversity loss. Exploring positive and negative implications of fortified foods and supplementation in relation to nutrient intake, health and environmental sustainability may be needed. Implementing dietary transition requires solutions beyond FBDG to ensure affordability, acceptability and ease of adaption.

Responses to the updated Nutri-Score algorithms in Norway: A qualitative study among food system actors in the NewTools-project.

Nutri-Score is a front-of-pack label grading foods and beverages from A to E indicating nutritional quality based on the foods' favorable and unfavorable components, and a contender in the ongoing debate on the possible implementation of a harmonized mandatory front-of-pack nutrition label in the European Union. NewTools is a research project on scoring systems for foods involving 28 partners representing actors involved in the Norwegian food system. This study aimed to explore views reported by Norwegian food system actors on the advantages and disadvantages with the updated Nutri-Score algorithms for food and beverages (2022-2023). This included Nutri-Score's performance in ranking foods according to the national food-based dietary guidelines and to the nutritional challenges in Norway. A total of 28 project partners and 15 other food system stakeholders following the NewTools-project were invited to provide responses on the Nutri-Score algorithms and their application on foods and beverages in the Norwegian food composition table. Thirteen written responses were received and analyzed with qualitative content analysis. The responses to the updated Nutri-Score varied in content, reflecting mainly concerns. Examples of perceived concerns included excessive penalty of salt content; insufficient differentiation based on fat content in meat, sausages, cheese, and milk; and several unreasonable comparisons across food categories. They also expressed a concern that Nutri-Score may stimulate to increased food processing, and some reported inconsistencies between Nutri-Score's classification of foods and national nutrition guidelines and policies. Several concerns with the updated Nutri-Score algorithms were raised, including the weighting of specific nutrients, unfair outcomes when comparing across food categories, and inconsistencies with established Norwegian nutrition guidelines and policies. The results should be interpreted with caution, as some perspectives from the Norwegian food system may be missing.

Beans, peas and pulses for improved public and planetary health: Changing UK consumption patterns

Beans, peas and pulses offer significant nutritional, health and environmental benefits (1,2,3, 4) and the FAO states that including pulses in agrifood systems is key to achieving the Sustainable Development Goals(5). Recommended intakes vary across national food-based dietary guidelines(6), but higher intakes are associated with benefits including increased satiety, reduced blood pressure, lower risk of cardiovascular disease and improved gut microbiota composition and activity(7). Worldwide, the average consumption of pulses is 21g per person per day(8) but published analysis of UK intakes is scarce. The aim of this review was to analyse consumption trends using two UK government datasets.The Family Food module of the Living Costs and Food Survey details food and drink purchases from approximately 5000 households per year(9). The ‘UK – household purchases’ data include the average (mean) quantities purchased per person per week. Categories relating to beans, peas and pulses were identified, and data were presented as graphs of purchasing trends (1974–2021).The National Diet and Nutrition Survey (NDNS)(10) assesses the nutritional status of 1000 participants (1.5 years and over) annually. Personal-level dietary data (2008-2019) were evaluated for subgroups ‘baked beans’ and ‘beans and pulses including ready meal and homemade dishes’, including fresh, frozen and canned beans and pulses, and recipes containing them. Peas/ green beans were excluded because of the nature of the data aggregation. Food-level dietary data (2018-19) were assessed for the frequency of consumption of different types of peas, beans and pulses.Our analysis of the Family Food datasets shows that, at 28g per person per day, the current average (mean) consumption of beans, peas and pulses in the UK is suboptimal. Our parallel analysis of NDNS data showed that more than 40% of participants were not eating any beans and pulses (excluding peas).Dietary trends are shifting. The overall consumption of beans, peas and pulses has been falling steadily since the late 1980s. This is mostly due to the drop in consumption of peas and baked beans, though these are still the most frequently consumed legume categories in the UK diet. Canned pea purchases fell from 88g per person per week in 1974 to 14g per person per week in 2020-21. Baked bean purchases peaked at 133g per person per week in 1986, dropping to 78g in 2020-21.Purchases of other canned beans and pulses (excluding baked beans) have increased noticeably in the last decade, from 17g per person per week 2015-16 to 32g in 2020-21. Purchases of dried pulses have remained consistent, averaging 11g per person per week in 2020-21.This analysis indicates significant scope to deliver affordable, accessible health and environmental benefits through increased consumption of beans, peas and pulses in the UK.

Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability.

Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.

Building a score of climate change mitigation potential in national food-based dietary guidelines

Abstract Background The food sector contributes to a third of global Greenhouse gas emissions. Food-based dietary guidelines (FBDG) are policy tools that provide food advice compatible with health. There is a growing effort to include environmental sustainability in dietary guidelines, but less is known about the extent to which different countries include dietary recommendations with climate change mitigation potential. Methods Based on a systematic review and quantitative content analysis of food-based dietary guidelines (FBDG), a Dietary Climate Mitigation (DCM) score was developed to assess and rank the climate change mitigation potential of dietary guidelines at three levels: food life cycle, dietary patterns, and food groups. To avoid an overestimation of recommendations with relatively lower climate mitigation potential, the overall DMC score assigns higher weights to the dietary patterns and food groups sub-scores, compared to the food life cycle sub-score. Results Of the selected 92 countries, 38 mention environmental sustainability in their dietary guidelines. The Dietary Climate Mitigation (DCM) score ranged 4-84 (median 31.14 IQR 19.71-39.14, score range 0-100). Scores were significantly higher in high-income countries, dietary guidelines published after 2010, and those that explicitly address environmental sustainability. The highest scores are those from Belgium-Flemish, Australia, Zambia, Israel, Spain, Netherlands, Seychelles, Denmark, Sweden, and United Kingdom. Food advice with high climate mitigation potential are less frequent than advice with relatively lower mitigation potential. Conclusions Future dietary guidelines can be more aligned to health and climate goals if they factor in the differential environmental footprints of food choices. Explicit inclusion of environmental considerations in dietary advice has grown, yet most guidelines can still evolve from pro-environmental (intent-based), to environmentally significant (impact-based) food advice. Key messages • While there is a growth in dietary guidelines that mention environmental sustainability, most countries have still a low coverage of food recommendations with high climate mitigation potential. • To be compatible with planetary health, dietary guidelines can benefit from an impact-weighted approach to dietary advice.

Environmental and nutritional assessment of young children’s diets in Norway: comparing the current diet with national dietary guidelines and the EAT-Lancet reference diet

PurposeIntroducing healthy and sustainable diets early in life can promote lifelong healthy dietary patterns with a low environmental impact. Therefore, we aimed to estimate the environmental and nutritional consequences of a dietary change for 2-year-old children in Norway towards healthier dietary patterns.MethodsEnvironmental impacts of the current habitual diet among 2-year-olds (n = 1413) were estimated for six impact categories and compared with scenario diets based on the Norwegian food-based dietary guidelines (FBDG) and the EAT-Lancet Commission reference diet. Last, we evaluated the nutritional adequacy of the diets against the Norwegian nutrition recommendations for children aged 2–5 years. The current diet was assessed by an FFQ.ResultsEnvironmental impacts of the current habitual diet were up to two times higher than those of the scenario diets. Compared with the current diet, impacts from the FBDG scenario diet were reduced by 35% for water use and 18% for terrestrial acidification, whereas impacts from the EAT-Lancet scenario diet were reduced by 51% for water use, 57% for terrestrial acidification, 36% for global warming potential and 27% for freshwater eutrophication. Milk and dairy products were the main contributors to environmental impacts in both the current diet and the FBDG scenario diet. The scenario diets were nutritionally adequate and improved the dietary quality among Norwegian 2-year-olds.ConclusionCompared to current diets among young children, more plant-based dietary patterns in line with national FBDG or the EAT-Lancet Commission reference diet can improve the nutritional adequacy of diets and simultaneously reduce environmental impacts.

Cost and affordability of a healthy diet for urban populations in Thailand and the Philippines before and during the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic severely affected global food security, but analyses of its impact on the cost and affordability of a healthy diet are limited. This study examines the immediate effect of the COVID-19 pandemic on the cost and affordability of a healthy diet among urban households in Bangkok, Thailand and Manila, the Philippines.MethodsWe used official food price and household income and food expenditure data from the national statistics offices. The cost of recommended diet (CoRD) method was employed to assess the minimum cost of a healthy diet, following the healthy diet recommendations provided in the national food-based dietary guidelines of the specific countries. Regression discontinuity design was estimated to determine the COVID-19 effect on food prices and scenario analysis done to determine the effect of reduced food budgets with and without government relief programs.ResultsThe results show that the average cost of the recommended diet was US$ 1.55 per person/day in Bangkok and US$ 3.76 in Manila (2019 prices in purchasing power parities) immediately before the pandemic. This diet is generally affordable for all households in Bangkok, but only for 37% of households (4.98 million people) in Manila, indicating much higher poverty in the latter. The pandemic and associated government measures decreased the cost of the recommended diet with 6.5% in Bangkok (p = 0.001) but not in Manila (p = 0.167). Assuming contractions in people’s food budgets of 15–20%, the recommended diet became unaffordable for 0.08–0.12 million people in Bangkok and 6.32–7.73 million people in Manila during the pandemic. Government relief largely compensated for this loss in Bangkok, but relief payments in Manila were not enough to compensate the effect.ConclusionThese results show that the main effect of the COVID-19 pandemic on the affordability of healthy diets was through the effect on reduced incomes of the poor rather than through prices. Government relief measures should target low-income households to give them the means to purchase healthy food items.

Inadequate dietary diversity during pregnancy increases the risk of maternal anemia and low birth weight in Africa: A systematic review and meta-analysis.

Inadequately diversified food consumption during pregnancy can lead to micronutrient deficiencies, which can affect maternal and newborn health outcomes. Previous studies on maternal dietary diversity have either been limited to a specific geographical region or consist entirely of systematic reviews, without meta-analyses. Thus, this study aimed to determine the pooled estimate of the association between inadequate dietary diversity during pregnancy, maternal anemia, and low birth weight in Africa. A systematic review of observational studies published between January 2000 and April 2022 was undertaken using the Google Scholar, PubMed, and CINAHL databases. The PRISMA checklist was followed to present the results. Microsoft Excel was used to abstract the data. STATA version 17 was used to analyze the data, and a random-effects meta-analysis model was applied to compute the pooled estimates. The study was registered in PROSPERO with protocol number CRD42022320873. A total of 22 publications with 9,696 participants were included in the final meta-analysis. The pooled adjusted odds ratio (AOR) for inadequate dietary diversity and maternal anemia was 2.15 (95% CI, 1.66-2.65), while that for low birth weight was 2.04 (95% CI, 1.46-2.63). The highest pooled estimate of maternal anemia was reported in Cameroon (AOR = 9.8, 95% CI: 1.68-17.92), followed by Ethiopia (AOR = 2.6, 95% CI: 1.95-3.25). Similarly, the pooled estimates of low birth weight were highest in Cameroon (AOR = 3.04, 95% CI: 1.19-4.88) and Ethiopia (AOR = 1.8, 95% CI: 1.29-2.39). In Africa, pregnant mothers with inadequate dietary diversity are two times more likely to develop anemia and low birth weight. Social protection policies that prioritize pregnant women, maternal nutrition promotion in the community, and dietary counseling during antenatal care visits, using national food-based dietary guidelines, should be strengthened.

European dietitians as key agents of the green transition: An exploratory study of their knowledge, attitudes, practices, and training.

How food systems are currently provisioning food to the population is a matter of debate worldwide. Food systems, driven by widespread and increasing adherence to a westernized dietary pattern, are failing to meet people's basic needs and are draining natural resources. There is a push to make food systems more healthy, fair, and sustainable. To this end, action from all players is needed to meet the international agenda. In this regard, dietitians play a crucial role, as they can provide advice and promote actions that foster the adoption of more sustainable dietary patterns (SDP) as well as the promotion of sustainable food systems. As an emerging requirement in their training, it is crucial to know what dietitians know about SDP as well as their attitudes and current practices in this field in order to strengthen their competences and be key agents for the green transition. For this reason, the aim of the present study is to explore the knowledge, attitudes, practices, and training (KAPT) of European dietitians on SDP by administering an online survey. Cross-sectional survey administered between April-August 2021 to dietitians based in the European countries with National Dietetic Associations or Education Associate Members affiliated to the European Federation of Associations of Dietitians (EFAD). Results were analyzed based on European region of professional practice (Northern/Southern/Western/South-East Europe), area of expertise and years of experience. Responses from 2211 dietitians from 25 countries were received, although the analysis was based on those that responded at least 90% of the survey (n=208). European dietitians are lacking training on SDP but are willing to learn more about it. Most dietitians perceive themselves as able to define an SDP, although aspects concerning social and economic sustainability were underestimated. Dietitians concur that barriers exist to the promotion of SDP, such as the lack of updated national food-based dietary guidelines and the absence of support from peers and managers. The country of professional activity seemed to be key to influencing dietitians' KAPT. These results emphasize the need to strengthen European dietitians' training in SDP and increase public/private commitment to consider dietitians as key professionals for the transition towards SDP.

From harmful nutrients to ultra-processed foods: exploring shifts in 'foods to limit' terminology used in national food-based dietary guidelines.

The choice of terms used to describe 'foods to limit' (FTL) in food-based dietary guidelines (FBDG) can impact public understanding, policy translation and research applicability. The choice of terms in FBDG has been influenced by available science, values, beliefs and historical events. This study aimed to analyse the terms used and definitions given to FTL in FBDG around the world, including changes over time and regional differences. A review of terms used to describe FTL and their definitions in all current and past FBDG for adults was conducted, using a search strategy informed by the FAO FBDG website. Data from 148 guidelines (96 countries) were extracted into a pre-defined table and terms were organised by the categories 'nutrient-based', 'food examples' or 'processing-related'. National FBDG from all world regions. None. Nutrient-based terms (e.g. high-fat foods) were the most frequently used type of term in both current and past dietary guidelines (91 %, 85 %, respectively). However, food examples (e.g. cakes) and processing-related terms (e.g. ultra-processed foods) have increased in use over the past 20 years and are now often used in conjunction with nutrient-based terms. Regional differences were only observed for processing-related terms. Diverse, and often poorly defined, terms are used to describe FTL in FBDG. Policymakers should ensure that FTL terms have clear definitions and can be integrated with other disciplines and understood by consumers. This may facilitate the inclusion of the most contemporary and potentially impactful terminology in nutrition research and policies.

A comparative analysis of sustainability of the usual food intakes of the Iranian population, Iranian food-based dietary guidelines, and optimized dietary models

Promoting sustainable diets might contribute toward achieving sustainable development goals. Considering the importance of national food-based dietary guidelines (FBDGs), this study aimed to assess and compare the sustainability dimensions of the usual Iranian dietary intakes with sustainable optimal diets based on Iranian (2006 and 2015 versions), Mediterranean, and vegetarian FBDGs. The usual dietary intakes of Iranian households were estimated using household expenditure survey data. Diet sustainability, including environmental (water, carbon, and land) footprints, cost, and nutrient-rich food (NRF) index, was calculated for the usual diet and compared with those of different FBDGs. Using linear and goal programming, optimal food models were calculated by minimizing environmental footprints and cost and maximizing NRF simultaneously for each FBDG, while maintaining nutritional considerations recommended by the FBDGs. Replacing the usual dietary intake of Iranians with the optimal diet based on the 2016 Iranian FBDG was associated with reductions equal to 20.9% for water footprint, 22.48% for carbon footprint, 20.39% for land footprint, 31.83% for cost, and 7.64% increase in NRF index. The optimal model based on the 2016 Iran FBDG was 10% more sustainable compared with the 2005 version. Changing the usual consumption of Iranians to the optimal model based on the Mediterranean pyramid was accompanied by the highest NRF index, lower environmental footprints, and cost compared to other models. The recent Iranian FBDG, compared with the older one, was more sustainable. Considering the dimensions of a sustainable diet for future FBDG revisions is recommended.

The fish paradox: people with low socio-economic status are not consuming the right type of fish

Abstract Background Fish intake is included in several national food-based dietary guidelines as a component of healthy diet because of its rich source of beneficial omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, heterogeneity among types of fish intake is rarely studied. We investigated the associations of socio-economic status (SES) with total and types of fish intake and validated whether types of fish intake was associated with plasma EPA and DHA. Methods From the Lifelines cohort study, 94 246 participants aged 44 ± 13 years old were included to test the association of two SES indicators, i.e., education level and income level, with dietary intakes of total, fatty, lean, fried, and other types of fish. Plasma EPA and DHA were measured in a minor subset of 575 participants (mean age: 50 ± 13 years old). Total and types of fish intake was assessed using Food Frequency Questionnaire. Linear regressions were applied, adjusted for relevant covariates. Results After adjusting for covariates, middle and low education were negatively associated with total, fatty, lean, and other fish intake (p < 0.001 for all), and positively associated with fried fish intake (β (SE): 0.04 (0.04), p < 0.001 for middle education; 0.07 (0.04), p < 0.001 for high education), with high education as the reference group. Similar results were observed for income level. In the subset population, total and fatty fish were positively associated with plasma EPA and DHA (p < 0.02 for all). Lean and other fish intake were positively associated with only DHA (p < 0.008 for all), but not EPA, while fried fish was not associated with either EPA or DHA in plasma (p > 0.1 for all). Conclusions Lower SES was associated with higher intake of fried fish, which did not seem to be associated with the fish-based EPA and DHA in plasma. Both nutrition education and food price policy could be implemented to increase the awareness and shape people's choice on types of fish. Key messages • People with low socio-economic status are consuming the type of fish that is not associated with fish-based omega-3 fatty acids, so nutrition education focusing on avoidance of fried fish is needed. • Food subsidy programs promoting intake and increasing affordability of healthier fish are needed to improve the nutritional awareness and status of our population.

Perception of proposed preliminary food-based dietary guidelines for Lake Victoria region of Kenya: findings from a qualitative study among adult community members

Background: Diets in the Lake Victoria region of Kenya have been described as monotonous, consisting chiefly of starchy staple foods, accompanied by green vegetables and oil. To promote healthy eating in the region, 11 food-based dietary guidelines (FBDGs) were proposed. Objective: This study was designed to assess perception of the proposed FBDGs amongst consumers in Lake Victoria region. Design and setting: A qualitative, descriptive cross-sectional design was used to collect data from 36 focus-group discussions (FGD) among adult males (18) and females (18) in Kisumu and Homa Bay Counties. Subjects: A total of 207 adult males (26–74 years) and 211 females (18–71 years) participated in this study. Data collection and analysis: Proposed FBDGs were printed on posters and presented to FGD participants. Proceedings were audio-taped, transcribed, translated and analysed based on themes. Results: The proposed FBDGs were perceived as promoting the consumption of a balanced diet. As a concept, a balanced diet was misrepresented as composed of only three nutrients: carbohydrates, proteins and vitamins. There was no mention of fats/oils and minerals as other significant nutrient constituents of a balanced diet. Other concepts, which included ‘three regular meals’, ‘snacks’, ‘food variety’, ‘healthy and physically active lifestyle’, were polysemous. Conclusion: The findings provide insight to guide the adaptation of the national FBDGs. The findings also provide a basis for nutrition advocacy programmes and a rationale for the revision of nutrition education materials, including the school curriculum, to align content with current evidence-based information.

The compatibility of circularity and national dietary recommendations for animal products in five European countries: a modelling analysis on nutritional feasibility, climate impact, and land use

National food-based dietary guidelines (FBDGs) are generally designed from a human health perspective and often disregard sustainability aspects. Circular food production systems are a promising solution to achieve sustainable healthy diets. In such systems, closing nutrient cycles where possible and minimising external inputs contribute to reducing environmental impacts. This change could be made by limiting livestock feed to available low-opportunity-cost biomass (LOCB). We examined the compatibility of national dietary guidelines for animal products with livestock production on the basis of the feed supplied by available LOCB. We investigated whether the national dietary recommendations for animal products for Bulgaria, Malta, the Netherlands, Sweden, and Switzerland could be met with domestically available LOCB. We used an optimisation model that allocates feed resources to different species of farm animals. Of the resulting scenarios, we assessed the nutritional feasibility, climate impact, and land use. Our results showed the environmental benefits of reducing the recommended animal products in the FBDGs, and that animal products from LOCB could provide between 22% (Netherlands) and 47% (Switzerland) of total protein contributions of the FBDGs. This range covers a substantial part of the nutritional needs of the studied populations. To fully meet these needs, consumption of plant-based food could be increased. Our results contribute to the discussion of what quantities of animal products in dietary guidelines are compatible with circular food systems. Thus, national dietary recommendations for animal products should be revised and recommended quantities lowered. This finding is consistent with recent efforts to include sustainability criteria in dietary guidelines. Swiss National Science Foundation and the Dutch Research Council.

A review of Ghana’s food system and its implications on sustainability and the development of national food-based dietary guidelines

Food-Based Dietary Guidelines (FBDG) provide culturally-appropriate and actionable recommendations based on which populations can make healthy food choices. Food systems sustainability, from production to consumption, and disposal of food and food-related items, should be a critical consideration for developing such guidelines. This rapid review assesses Ghana's food systems to determine the level of sustainability to inform the FBDG recommendations. Peer-reviewed articles, documents and reports of relevance to Ghana were included in this rapid review. A hundred and eight papers, answering different questions on food system sustainability were reviewed. Bread, cereals, fish and indigenous vegetables are the most frequently consumed food groups. Sugar-Sweetened Beverages are the most consumed imported foods. In rural areas, 53% of dietary protein comes from plant sources. Fish is the main the source of animal protein for most Ghanaian households. There is intensive exploitation of marine and fresh water resources. Most livestock are raised by smallholder farmers using free-range system. Poultry is frequently kept on deep litter system and only a few are large-scale. Crop production for household consumption and small-scale animal rearing are predominant, especially in Northern Ghana. By weight, fruits and vegetables are the least cultivated and consumed crops at the household level. Wood is the commonest source of fuel for cooking, especially in rural areas. Single use plastic is the most used and preferred material for food packaging. Indiscriminate and poor management of waste and pesticide misuse is commonly reported. The findings suggest the need for promoting production diversification, use of clean fuel and reusable food packaging as part of FBDGs to enhance sustainability of Ghana’s food systems. Key words: sustainability, food system, Ghana, Food-based Dietary Guidelines, production, diversification

Do Children and Adolescents with Overweight or Obesity Adhere to the National Food-Based Dietary Guidelines in Greece?

Childhood obesity increases the risk for metabolic disorders, but is also related to nutritional deficiencies, such as anemia and hypovitaminosis D. Although children/adolescents with overweight/obesity may have higher energy intake, their diet quality and diversity may be low. The present study aimed to evaluate the consumption of foods against the national food-based dietary guidelines in children and adolescents with overweight or obesity in Greece. Sociodemographic, anthropometric and lifestyle data were collected from a sample of 1467 children 2–18 years old (962 obese, 505 overweight, 51.2% females) in 2014–2017. The results of this study show that the consumption of dairy products, fruit, vegetables, legumes and fish by children/adolescents with overweight or obesity was lower than the national recommendations (ranging from a minimum of 39.5% for fish, to a maximum of 75.5% for cereal/potato/rice). Only the consumption of meat/poultry was found to exceed the national recommendation (estimated coverage of 131.3%). Moreover, a large proportion of participants regularly consumed various unhealthy foods/beverages. The present findings indicate that the majority of children/adolescents with overweight/obesity do not comply with the national food-based dietary guidelines in Greece. The implementation of new strategies to promote healthy diets among children/adolescents with overweight/obesity are urgently required.

Effectiveness of national food-based dietary guidelines in reducing cardiometabolic risk factors: a systematic review of randomised controlled trials

Effectiveness of national food-based dietary guidelines in reducing cardiometabolic risk factors: a systematic review of randomised controlled trials

Factors Related to Diet Quality: A Cross-Sectional Study of 1055 University Students.

Given that there is only a limited body of evidence available concerning the dietary habits of Spanish university students, the present study assesses the quality of this group’s diet, their adherence to the National Food-Based Dietary Guidelines, and the predictive factors of their diet quality. To do so, a cross-sectional study was performed on a sample of 1055 students. The quality of the participants’ diets was then analysed by using the Spanish Healthy Eating Index, and then their level of compliance was assessed in light of the dietary recommendations put forth by the Spanish Society for Community Nutrition. According to these standards, only 17.4% of the participants had a healthy diet. The level of compliance with the recommendations was poor, highlighting especially the low levels of “fruit” and “vegetables” that they consumed as well as high levels of “cold meats and cuts” and “sweets”. The factors that predicted a worse diet are being male, living alone, low levels of physical activity, smoking, high alcohol intake, leading a sedentary lifestyle, psychological distress, and insomnia (p < 0.005). Furthermore, participants with low or high body weights showed signs of a higher quality diet (p < 0.001). The present findings suggest that a significant proportion of university students ought to change their dietary habits; these also attest to the importance of developing strategies that are directly targeted at university students in order to promote a healthy diet.