Gabriel Masset

Reducing energy intake and energy density for a sustainable diet: a study based on self-selected diets in French adults

BACKGROUNDnStudies on theoretical diets are not sufficient to implement sustainable diets in practice because of unknown cultural acceptability. In contrast, self-selected diets can be considered culturally acceptable.nnnOBJECTIVEnThe objective was to identify the most sustainable diets consumed by people in everyday life.nnnDESIGNnThe diet-related greenhouse gas emissions (GHGE) for self-selected diets of 1918 adults participating in the cross-sectional French national dietary survey Individual and National Survey on Food Consumption (INCA2) were estimated. Lower-Carbon, Higher-Quality, and More Sustainable diets were defined as having GHGE lower than the overall median value, a probability of adequate nutrition intake (PANDiet) score (a measure of the overall nutritional adequacy of a diet) higher than the overall median value, and a combination of both criteria, respectively. Diet cost, as a proxy for affordability, and energy density were also assessed.nnnRESULTSnMore Sustainable diets were consumed by 23% of men and 20% of women, and their GHGE values were 19% and 17% lower than the population average (mean) value, respectively. In comparison with the average value, Lower-Carbon diets achieved a 20% GHGE reduction and lower cost, but they were not sustainable because they had a lower PANDiet score. Higher-Quality diets were not sustainable because of their above-average GHGE and cost. More Sustainable diets had an above-average PANDiet score and a below-average energy density, cost, GHGE, and energy content; the energy share of plant-based products was increased by 20% and 15% compared with the average for men and women, respectively.nnnCONCLUSIONSnA strength of this study was that most of the dimensions for sustainable diets were considered, ie, not only nutritional quality and GHGE but also affordability and cultural acceptability. A reduction in diet-related GHGE by 20% while maintaining high nutritional quality seems realistic. This goal could be achieved at no extra cost by reducing energy intake and energy density and increasing the share of plant-based products.

Consumption of dairy products and associations with incident diabetes, CHD and mortality in the Whitehall II study

Few prospective studies have examined the effects of different types of dairy food on the risks of type 2 diabetes, CHD and mortality. We examined whether intakes of total dairy, high-fat dairy, low-fat dairy, milk and fermented dairy products were related to these outcomes in the Whitehall II prospective cohort study. At baseline, dairy consumption was assessed by FFQ among 4526 subjects (72% men) with a mean age 56 (sd 6) years. Death certificates and medical records were used to ascertain CHD mortality and non-fatal myocardial infarction. Incident diabetes was detected by the oral glucose tolerance test or self-report. Incidence data were analysed using Cox proportional hazards models, adjusted for lifestyle and dietary factors. During approximately 10 years of follow-up, 273 diabetes, 323 CHD and 237 all-cause mortality cases occurred. In multivariable models, intakes of total dairy and types of dairy products were not significantly associated with incident diabetes or CHD (all P values for trend >0·1). Fermented dairy products was inversely associated with overall mortality (hazard ratios approximately 0·7 in the middle and highest tertiles; P for trend < 0·01) but not with incident CHD or diabetes (P>0·3). In conclusion, intakes of total dairy and types of dairy products showed no consistent relationship with incident diabetes, CHD or all-cause mortality.

Identifying Sustainable Foods: The Relationship between Environmental Impact, Nutritional Quality, and Prices of Foods Representative of the French Diet

BACKGROUNDnSustainable diets, as defined by the Food and Agriculture Organization, need to combine environment, nutrition, and affordability dimensions. However, it is unknown whether these dimensions are compatible, and no guidance is available in the official recommendations.nnnOBJECTIVEnTo identify foods with compatible sustainability dimensions.nnnMETHODSnFor 363 of the most commonly consumed foods in the Second French Individual and National Study on Food Consumption, environmental impact indicators (ie, greenhouse gas [GHG] emissions, acidification, and eutrophication), and prices were collected. The nutritional quality of the foods was assessed by calculating the score for the nutritional adequacy of individual foods (SAIN) to score for disqualifying nutrients (LIM) ratio. A sustainability score based on the median GHG emissions, price, and SAIN:LIM was calculated for each food; the foods with the best values for all three variables received the highest score.nnnRESULTSnThe environmental indicators were strongly and positively correlated. Meat, fish, and eggs and dairy products had the strongest influence on the environment; starchy foods, legumes, and fruits and vegetables had the least influence. GHG emissions were inversely correlated with SAIN:LIM (r=-0.37) and positively correlated with price per kilogram (r=0.59); the correlation with price per kilocalorie was null. This showed that foods with a heavy environmental impact tend to have lower nutritional quality and a higher price per kilogram but not a lower price per kilocalorie. Using price per kilogram, 94 foods had a maximum sustainability score, including most plant-based foods and excluding all foods with animal ingredients except milk, yogurt, and soups. Using price per kilocalorie restricted the list to 42 foods, including 52% of all starchy foods and legumes but only 11% of fruits and vegetables (mainly 100% fruit juices).nnnCONCLUSIONSnOverall, the sustainability dimensions seemed to be compatible when considering price per kilogram of food. However, this conclusion is too simplistic when considering price per kilocalorie, which highlights the need to integrate the data at the diet level.

Diet Optimization Methods Can Help Translate Dietary Guidelines into a Cancer Prevention Food Plan

Mathematical diet optimization models are used to create food plans that best resemble current eating habits while meeting prespecified nutrition and cost constraints. This study used linear programming to generate food plans meeting the key 2007 dietary recommendations issued by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR). The models were constructed to minimize deviations in food intake between the observed and the WCRF/AICR-recommended diets. Consumption constraints were imposed to prevent food plans from including unreasonable amounts of food from a single group. Consumption norms for nutrients and food groups were taken from dietary intake data for a sample of adult men and women (n = 161) in the Pacific Northwest. Food plans meeting the WCRF/AICR dietary guidelines numbers 3-5 and 7 were lower in refined grains and higher in vegetables and fruits than the existing diets. For this group, achieving cancer prevention goals required little modification of existing diets and had minimal impact on diet quality and cost. By contrast, the need to meet all nutritional needs through diet alone (guideline no. 8) required a large food volume increase and dramatic shifts from the observed food intake patterns. Putting dietary guidelines into practice may require the creation of detailed food plans that are sensitive to existing consumption patterns and food costs. Optimization models provide an elegant mathematical solution that can help determine whether sets of dietary guidelines are achievable by diverse U.S. population subgroups.

Improving diet sustainability through evolution of food choices: review of epidemiological studies on the environmental impact of diets

The Food and Agriculture Organization defines sustainable diets as nutritionally adequate, safe, healthy, culturally acceptable, economically affordable diets that have little environmental impact. This review summarizes the studies assessing, at the individual level, both the environmental impact and the nutritional quality or healthiness of self-selected diets. Reductions in meat consumption and energy intake were identified as primary factors for reducing diet-related greenhouse gas emissions. The choice of foods to replace meat, however, was crucial, with some isocaloric substitutions possibly increasing total diet greenhouse gas emissions. Moreover, nutritional adequacy was rarely or only partially assessed, thereby compromising the assessment of diet sustainability. Furthermore, high nutritional quality was not necessarily associated with affordability or lower environmental impact. Hence, when identifying sustainable diets, each dimension needs to be assessed by relevant indicators. Finally, some nonvegetarian self-selected diets consumed by a substantial fraction of the population showed good compatibility with the nutritional, environmental, affordability, and acceptability dimensions. Altogether, the reviewed studies revealed the scarcity of standardized nationally representative data for food prices and environmental indicators and suggest that diet sustainability might be increased without drastic dietary changes.

How low can dietary greenhouse gas emissions be reduced without impairing nutritional adequacy, affordability and acceptability of the diet? A modelling study to guide sustainable food choices.

OBJECTIVEnTo assess the compatibility between reduction of diet-related greenhouse gas emissions (GHGE) and nutritional adequacy, acceptability and affordability dimensions of diet sustainability.nnnDESIGNnDietary intake, nutritional composition, GHGE and prices were combined for 402 foods selected among those most consumed by participants of the Individual National Study on Food Consumption. Linear programming was used to model diets with stepwise GHGE reductions, minimized departure from observed diet and three scenarios of nutritional constraints: none (FREE), on macronutrients (MACRO) and for all nutrient recommendations (ADEQ). Nutritional quality was assessed using the mean adequacy ratio (MAR) and solid energy density (SED).nnnSETTINGnFrance.nnnSUBJECTSnAdults (n 1899).nnnRESULTSnIn FREE and MACRO scenarios, imposing up to 30 % GHGE reduction did not affect the MAR, SED and food group pattern of the observed diet, but required substitutions within food groups; higher GHGE reductions decreased diet cost, but also nutritional quality, even with constraints on macronutrients. Imposing all nutritional recommendations (ADEQ) increased the fruits and vegetables quantity, reduced SED and slightly increased diet cost without additional modifications induced by the GHGE constraint up to 30 % reduction; higher GHGE reductions decreased diet cost but required non-trivial dietary shifts from the observed diet. Not all the nutritional recommendations could be met for GHGE reductions ≥70 %.nnnCONCLUSIONSnModerate GHGE reductions (≤30 %) were compatible with nutritional adequacy and affordability without adding major food group shifts to those induced by nutritional recommendations. Higher GHGE reductions either impaired nutritional quality, even when macronutrient recommendations were imposed, or required non-trivial dietary shifts compromising acceptability to reach nutritional adequacy.

Rising adiposity curbing decline in the incidence of myocardial infarction: 20-year follow-up of British men and women in the Whitehall II cohort

Aims To estimate the contribution of risk factor trends to 20-year declines in myocardial infarction (MI) incidence in British men and women. Methods and results From 1985 to 2004, 6379 men and 3074 women in the Whitehall II cohort were followed for incident MI and risk factor trends. Over 20 years, the age–sex-adjusted hazard of MI fell by 74% (95% confidence interval 48–87%), corresponding to an average annual decline of 6.5% (3.2–9.7%). Thirty-four per cent (20–76%) of the decline in MI hazard could be statistically explained by declining non-HDL cholesterol levels, followed by increased HDL cholesterol (17%, 10–32%), reduced systolic blood pressure (13%, 7–24%), and reduced cigarette smoking prevalence (6%, 2–14%). Increased fruit and vegetable consumption made a non-significant contribution of 7% (−1–20%). In combination, these five risk factors explained 56% (34–112%). Rising body mass index (BMI) was counterproductive, reducing the scale of the decline by 11% (5–23%) in isolation. The MI decline and the impact of the risk factors appeared similar for men and women. Conclusion In men and women, over half of the decline in MI risk could be accounted for by favourable risk factor time trends. The adverse role of BMI emphasizes the importance of addressing the rising population BMI.

Vitamins, minerals, essential fatty acids and colorectal cancer risk in the United Kingdom Dietary Cohort Consortium

The risk for colorectal cancer may be influenced by the dietary intake of various vitamins, minerals and essential fatty acids. We conducted a pooled analysis of dietary data collected using food diaries in seven prospective studies in the United Kingdom Dietary Cohort Consortium. Five hundred sixty‐five cases of colorectal cancer were matched with 1,951 controls on study centre, age, sex and recruitment date. Dietary intakes of retinol, vitamin A, thiamin, riboflavin, vitamin B6, folate, vitamin B12, vitamin D, calcium, iron, magnesium, potassium, n − 6 fatty acids, n − 3 fatty acids and the ratio of n − 6 to n − 3 fatty acids were estimated and their associations with colorectal cancer examined using conditional logistic regression models, adjusting for exact age, height, weight, energy intake, alcohol intake, fiber intake, smoking, education, social class and physical activity. There were no statistically significant associations between colorectal cancer risk and dietary intake of any of the vitamins, minerals or essential fatty acids examined.

A nutrient profiling system for the (re)formulation of a global food and beverage portfolio

PurposeTo describe the Nestlé Nutritional Profiling System (NNPS) developed to guide the reformulation of Nestlé products, and the results of its application in the USA and France.DesignThe NNPS is a category-specific system that calculates nutrient targets per serving as consumed, based on age-adjusted dietary guidelines. Products are aggregated into 32 food categories. The NNPS ensures that excessive amounts of nutrients to limit cannot be compensated for by adding nutrients to encourage. A study was conducted to measure changes in nutrient profiles of the most widely purchased Nestlé products from eight food categories (nxa0=xa099) in the USA and France. A comparison was made between the 2009–2010 and 2014–2015 products.ResultsThe application of the NNPS between 2009–2010 and 2014–2015 was associated with an overall downwards trend for all nutrients to limit. Sodium and total sugars contents were reduced by up to 22 and 31xa0%, respectively. Saturated Fatty Acids and total fat reductions were less homogeneous across categories, with children products having larger reductions. Energy per serving was reduced by <10xa0% in most categories, while serving sizes remained unchanged.ConclusionsThe NNPS sets feasible and yet challenging targets for public health-oriented reformulation of a varied product portfolio; its application was associated with improved nutrient density in eight major food categories in the USA and France. Confirmatory analyses are needed in other countries and food categories; the impact of such a large-scale reformulation on dietary intake and health remains to be investigated.

Which functional unit to identify sustainable foods

OBJECTIVEnIn life-cycle assessment, the functional unit defines the unit for calculation of environmental indicators. The objective of the present study was to assess the influence of two functional units, 100 g and 100 kcal (420 kJ), on the associations between three dimensions for identifying sustainable foods, namely environmental impact (via greenhouse gas emissions (GHGE)), nutritional quality (using two distinct nutrient profiling systems) and price.nnnDESIGNnGHGE and price data were collected for individual foods, and were each expressed per 100 g and per 100 kcal. Two nutrient profiling models, SAIN,LIM and UK Ofcom, were used to assess foods nutritional quality. Spearman correlations were used to assess associations between variables. Sustainable foods were identified as those having more favourable values for all three dimensions.nnnSETTINGnThe French Individual and National Dietary Survey (INCA2), 2006-2007.nnnSUBJECTSnThree hundred and seventy-three foods highly consumed in INCA2, covering 65 % of total energy intake of adult participants.nnnRESULTSnWhen GHGE and price were expressed per 100 g, low-GHGE foods had a lower price and higher SAIN,LIM and Ofcom scores (r=0·59, -0·34 and -0·43, respectively), suggesting a compatibility between the three dimensions; 101 and 100 sustainable foods were identified with SAIN,LIM and Ofcom, respectively. When GHGE and price were expressed per 100 kcal, low-GHGE foods had a lower price but also lower SAIN,LIM and Ofcom scores (r=0·67, 0·51 and 0·47, respectively), suggesting that more environment-friendly foods were less expensive but also less healthy; thirty-four sustainable foods were identified with both SAIN,LIM and Ofcom.nnnCONCLUSIONSnThe choice of functional unit strongly influenced the compatibility between the sustainability dimensions and the identification of sustainable foods.