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Assessing Sustainable Healthy Diets: Comparison
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Please note this is a comparison between Version 2 by Bruce Ren and Version 1 by M.d.Mar Rubio-Varas.

Research coupling human nutrition and sustainability concerns is a rapidly developing field, which is essential to guide governments’ policies. This critical and comprehensive review analyzes indicators and approaches to “sustainable healthy diets” published in the literature since this discipline’s emergence a few years ago, identifying robust gauges and highlighting the flaws of the most commonly used models. The reviewed studies largely focus on one or two domains such as greenhouse gas emissions or water use, while overlooking potential impact shifts to other sectors or resources.

  • sustainable healthy diet
  • food environmental sustainability
  • socioeconomic sustainability
  • indicators
  • constraints
  • costs

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1. Introduction

Environmental degradation and malnutrition, in all its forms, are both occurring at an accelerated pace around the world. While the causes are complex, unhealthy diets coupled with unsustainable food systems can be considered among the main contributors to these global burdens [1].

Referring to environmental sustainability, currently, the global food system is the largest freshwater user: agriculture alone accounts for 70% of freshwater withdrawn in the world [2]. Agriculture is also responsible for 21–37% of total greenhouse gas (GHG) emissions [3] and covers approximately 49–51% of global ice-free land surface, with grazing land representing 37% and croplands representing approximately 12–14% [4]. Intensive and unsustainable agricultural practices and pollution can also trigger biodiversity loss [5].

In regard to the health component, currently, an estimated 821 million people are undernourished, 151 million children under five years of age are stunted, 613 million women and girls aged 15 to 49 suffer from iron deficiency, and, on the other side, 2 billion adults are overweight or obese [3]. Nowadays, unhealthy and unbalanced diets pose an increased risk to morbidity and mortality.

The challenge of achieving healthy diets is coupled with the challenge of attaining sustainable food systems [6]. While food production contributes to natural resource depletion and diets should improve to overcome malnutrition, sustainable food consumption and production could also be considered an opportunity for enhancing human health and environmental sustainability.

In 2011, Riley and Buttriss raised the question on “which dietary patterns are both healthy and sustainable?”, although they were not able to provide a complete answer due to the complexity of the issue [7]. Given the divergence of approaches, in 2019, the FAO and WHO held a consultation and coined the concept “sustainable healthy diets”. This was defined as:

“dietary patterns that promote all dimensions of individuals’ health and wellbeing; have low environmental pressure and impact; are accessible, affordable, safe and equitable; and are culturally acceptable” [1]
[1]

Sustainable healthy diets must combine all the dimensions of sustainability to avoid unintended consequences. However, currently, a few dietary guidelines take environmental sustainability into account, such as those of the Netherlands [8], Nordic countries [9], Germany [10], Brazil [11], Sweden [12], Qatar [13] and France [14]. Furthermore, the papers published in the literature generally focus on specific aspects of health, environmental or socioeconomic sustainability, sometimes leaving out one or two of the three components. Further development of encompassing indicators and data on all dimensions of sustainability is needed to make this concept complete, useful and effective.

In recent years, there has been an increase in the number of systematic reviews focused on sustainable and healthy diets, most of which also have a specific scope. For instance, some of the reviews have a limited geographical reach, focusing on one country such as the UK [15] or the USA [16]. Other reviews focus on a specific domain such as mathematical optimization studies [17] or labeling schemes [18]. Most reviews have a specific environmental scope, analyzing a single environmental aspect [19,20] or two or three environmental resources [15,21,22]. Some leave socioeconomic aspects out of the scope of review, instead focusing on the interlinkages between the environment and diets [23,24]. Few reviews combine socioeconomic and environmental performance with nutritional and health indicators [17,25,26], and only three of these compile [27] and recommend [28,29] criteria. There has been no comprehensive review highlighting a complete set of indicators coupled with an analysis of the gaps of knowledge and misconceptions from a multidisciplinary perspective. Thus, limited evidence is available on the trade-offs involved in selecting sustainable healthy diets.

In recent years, there has been an increase in the number of systematic reviews focused on sustainable and healthy diets, most of which also have a specific scope. For instance, some of the reviews have a limited geographical reach, focusing on one country such as the UK [15] or the USA [16]. Other reviews focus on a specific domain such as mathematical optimization studies [17] or labeling schemes [18]. Most reviews have a specific environmental scope, analyzing a single environmental aspect [19][20] or two or three environmental resources [15][21][22]. Some leave socioeconomic aspects out of the scope of review, instead focusing on the interlinkages between the environment and diets [23][24]. Few reviews combine socioeconomic and environmental performance with nutritional and health indicators [17][25][26], and only three of these compile [27] and recommend [28][29] criteria. There has been no comprehensive review highlighting a complete set of indicators coupled with an analysis of the gaps of knowledge and misconceptions from a multidisciplinary perspective. Thus, limited evidence is available on the trade-offs involved in selecting sustainable healthy diets.

2. Healthy Sustainable Diets in the Literature

2.1. Healthy Diet

Some of the latest studies point to the following dietary recommendations in promoting overall wellbeing and low risk of major chronic disease: (1) protein sources primarily from plants, including soy foods; other legumes; and nuts, fish or alternative sources of n-3 polyunsaturated fatty acids (PUFA) consumed several times per week with optional modest consumption of poultry and eggs and low intakes of red meat, if any, and especially of processed meat; (2) fat obtained mostly from unsaturated plant sources with low intakes of saturated fats and no consumption of partly hydrogenated oils; (3) carbohydrates primarily from whole grains with low intake of refined grains and less than 5% of energy from sugar; (4) at least five daily servings of fresh fruits and non-starchy vegetables; and (5) optional moderate dairy consumption [6,31,32,33]. These components can be combined in various types of omnivore, vegetarian, and vegan diets [6]. This nutritional guidance improves the intake of most nutrients. However, specific cases of dietary inadequacies require obtaining nutrients from dietary supplements or enriched foods [34,35,36,37,38,39,40,41]. The most accepted nutritional criteria proposed for a healthy diet are summarized in

Some of the latest studies point to the following dietary recommendations in promoting overall wellbeing and low risk of major chronic disease: (1) protein sources primarily from plants, including soy foods; other legumes; and nuts, fish or alternative sources of n-3 polyunsaturated fatty acids (PUFA) consumed several times per week with optional modest consumption of poultry and eggs and low intakes of red meat, if any, and especially of processed meat; (2) fat obtained mostly from unsaturated plant sources with low intakes of saturated fats and no consumption of partly hydrogenated oils; (3) carbohydrates primarily from whole grains with low intake of refined grains and less than 5% of energy from sugar; (4) at least five daily servings of fresh fruits and non-starchy vegetables; and (5) optional moderate dairy consumption [6][30][31][32]. These components can be combined in various types of omnivore, vegetarian, and vegan diets [6]. This nutritional guidance improves the intake of most nutrients. However, specific cases of dietary inadequacies require obtaining nutrients from dietary supplements or enriched foods [33][34][35][36][37][38][39][40]. The most accepted nutritional criteria proposed for a healthy diet are summarized in

Table 1

.

Table 1.

Accepted nutritional criteria for defining a healthy diet (according to mainstream science) *.

Criteria Rationale Relevance and Comments References
Reduce intake of sugars Dietary sugars have been linked to dental caries, obesity, and cardiometabolic diseases, including type 2 diabetes (T2DM). Dietary sugars are not more harmful than excess of dietary energy. However, if the energy is excessive, a higher intake of added sugar (especially from sugar-sweetened beverages) might be associated with poorer diet quality and might increase the risk of caries, overweight, and T2DM. [42,43,44,45,46][41][42][43][44][45]
Reduce intake of saturated fat as much as possible
,146,147,148,149,150]. There are no standardized methodologies to perform LCAs for diets. Thus, authors add and discriminate environmental indicators in different ways, leading to a wide variety of studies that differ in scale and sets of environmental indicators, hindering data comparisons.

The two main approaches used to address the environmental sustainability of diets and food systems are life cycle analysis (LCA) and environmental footprints. LCA assesses the environmental impact of a product from resource extraction, manufacturing, and transport to use and end-of-life disposal [142]. Ideally, LCA studies cover every relevant environmental category. However, in the case of diet-related impact assessments, only a few environmental indicators are generally used to perform analyses. The most common and recurrent impact categories applied in these studies are climate change, freshwater use, land use, acidification, ecotoxicity, eutrophication, human toxicity, ionizing radiation, ozone depletion, particulate matter, photochemical ozone formation and resource depletion [143][144][145][146][147][148][149]. There are no standardized methodologies to perform LCAs for diets. Thus, authors add and discriminate environmental indicators in different ways, leading to a wide variety of studies that differ in scale and sets of environmental indicators, hindering data comparisons.

Environmental footprint approaches are able to pair food-production estimates with country-specific environmental footprints and compare them with planetary boundaries [151,152]. The footprint indicators used in sustainable diet studies are GHG emissions, freshwater use, land use and nitrogen, phosphorus application, biodiversity, energy and the ecological footprint [153,154,155,156,157,158,159,160,161]. However, many authors do not adopt these methodologies from a holistic perspective to assess the environmental impact from diets. The vast majority of studies take into consideration a single or few environmental aspects or impact categories (

Environmental footprint approaches are able to pair food-production estimates with country-specific environmental footprints and compare them with planetary boundaries [150][151]. The footprint indicators used in sustainable diet studies are GHG emissions, freshwater use, land use and nitrogen, phosphorus application, biodiversity, energy and the ecological footprint [152][153][154][155][156][157][158][159][160]. However, many authors do not adopt these methodologies from a holistic perspective to assess the environmental impact from diets. The vast majority of studies take into consideration a single or few environmental aspects or impact categories (

Table 2

). Therefore, the results obtained from these kinds of assessments have to be interpreted rigorously as they may show a reductionist outlook of the whole environmental impact.

Table 2.

Indicators of an environmentally sustainable diet *.

Environmental Concern Indicators and Definition Relevance and Comments References
Biodiversity loss Biodiversity footprint: biodiversity loss related to products and processes. Land conversion for crop and animal agriculture is the main driver of habitat loss, which currently continues to be the leading threat to biodiversity. Increasing crop yields, reducing deforestation and reducing meat consumption may be the most effective means to prevent biodiversity loss in future years. [164,165,166,161][162]167,[163]168][[164][165]
Energy consumption and greenhouse gas (GHG) emissions

[215].

2.3. Socioeconomic Approach to a Sustainable Healthy Diet

Food security remains the most significant challenge to the development of sustainable and healthy diets. Over 2 billion people, mostly in low- and middle-income countries, do not have regular access to safe, nutritious and sufficient food [217]. However, irregular access is also a challenge for high-income countries, including for 8% of the populations of North America and Europe. Most environmental studies on sustainable diets neglect or minimize socioeconomic factors, rendering their recommendations empirically unfeasible. Furthermore, there is a bias in the geographical focus of studies towards high- and middle-income countries. Of the country-specific studies analyzed, 121 address high-/middle-income countries, while only 26 focus on low-income countries. Dietary choices have macroeconomic and microeconomic implications for both the producer (supply) and consumer (demand) sides. Most studies identify criteria affecting consumer behavior—either affordability and/or acceptability (

Food security remains the most significant challenge to the development of sustainable and healthy diets. Over 2 billion people, mostly in low- and middle-income countries, do not have regular access to safe, nutritious and sufficient food [216]. However, irregular access is also a challenge for high-income countries, including for 8% of the populations of North America and Europe. Most environmental studies on sustainable diets neglect or minimize socioeconomic factors, rendering their recommendations empirically unfeasible. Furthermore, there is a bias in the geographical focus of studies towards high- and middle-income countries. Of the country-specific studies analyzed, 121 address high-/middle-income countries, while only 26 focus on low-income countries. Dietary choices have macroeconomic and microeconomic implications for both the producer (supply) and consumer (demand) sides. Most studies identify criteria affecting consumer behavior—either affordability and/or acceptability (

Table 3

). A small number of studies consider the distinct constraints that food producers face when adopting the production of healthy food and using methods that minimize environmental damage. Another strand of literature analyzes the value chains that take products from suppliers to the consumer. What is missing from the literature are comprehensive socioeconomic approaches based on criteria that affect supply and demand and the necessary value chains that connect them.

Table 3.

Socioeconomic indicators for a sustainable healthy diet*.

Criteria Comments References
Supply side indicators Those affecting the production and distribution of food
Cardiovascular diseases (CVDs) have been linked to saturated fat intake based on observational studies.
Scalability and feasibility Many of the assumptions of sustainable diet models are too rigid to resist empirical testing:
  • Perfect substitutability among foods;
  • Perfect substitutability of land for different forms of agrarian production;
  • Constant yield growth rates;
  • Resistance of organic agriculture to pests and climate patterns.
 A key question for any sustainable diet concerns whether it can be empirically implemented on a large scale.Cardiovascular diseases (CVDs) have been linked to saturated fat intake based on observational studies with contradictory results. Some studies question further limiting the intake of such fats. Effect of a specific saturated fatty acid should be considered and not “generic saturated fat”.

It is the higher intake of 		trans-fatty acids that is associated with greater risk of CVDs in a dose–response fashion. [218,219][217][218][47,48,49,50,51,52,53,54][46][47][48][49][50][51 Energy use: energy used in the production and/or cooking of a product or process.] Food production, transport and consumption require large inputs of energy that have a significant environmental impact. Energy consumption is commonly linked to GHG emissions, as energy generation methods are some of the main emission sources.

Global carbon emissions have increased by nearly 50% since 1990. Food production is one of the main causes of climate change.		[52][53]
[169][166] Reach a low n‑6:n‑3 ratio Anti-inflammatory and anti-aggregatory activities are linked to n‑3 PUFA. Conversely, the n‑6 PUFAs are considered precursors of pro-inflammatory and pro-aggregatory mediators. The same ratio can be obtained with different individual amounts of n
GHG emissions: release of greenhouse gases into the atmosphere. [170,171,172,173,174,175,176,][167]177,[168]178,[179,180,169-3 and n-6 PUFAs. The ratio is about 9.3 when linoleic, arachidonic, a-linolenic, docosahexaenoic, and eicosapentaenoic acids are only considered. This ratio is based on data association and not cause–effect studies. ][170][171][172][173][174][175][176][177]181[178][55,56,57,58][54][55][56][57]
Reduce intake of cholesterol From the 1960s, epidemiological studies have suggested that dietary cholesterol contributes to the increased risk of CVD. Evidence from observational studies conducted in different countries does not indicate a significant association with cardiovascular disease risk. Findings from intervention trials prove that dietary cholesterol does not increase plasma cholesterol. Likewise, the impact of dietary cholesterol on the immune response remains unclear.

Carbon footprint: total GHG emissions caused by a product or process, expressed as carbon dioxide equivalent. [182][179]Not all subjects respond equally to dietary cholesterol.

Dietary guidance focused on dietary patterns is more effective in improving diet quality and promoting cardiovascular health.		 [59,60,61,62,63,64,65,66,67,68,69,70][58][59][60][61][62][63][64][65][66][67][68][69]
Protein amount and source The recommended protein intake level (0.8 g/kg) was derived as a minimum amount to avoid the loss of body nitrogen.

Animal proteins have been linked to increased risk of many diseases (cancer, CVD, diabetes, osteoporosis, etc.)		 The recommended protein intake level (0.8 g/kg) was derived as a minimum amount to avoid the loss of body nitrogen. Higher protein intake can help maximize health benefits, particularly in older individuals. Amounts of protein above recommended do not appear to have harmful effects.

Food wasteIt is unclear whether the relation animal proteins–diseases (cancer, CVD, T2DM, osteoporosis, etc.) is indicative of a causative effect or due to other diet and lifestyle factors. The role of plant or animal proteins in diseases or mortality is difficult to isolate. If there is a difference, it is reduced. Evidence to date is inconclusive. Globally, plant protein consumption is not more advantageous than animal protein consumption and vice versa. Food waste and losses: decrease in the quantity or quality of food. Daily food waste per capita. Globally, 30% of food is wasted annually (IPCC, 2019). In fact, avoidable food waste represents the largest fraction of overall food waste. The environmental footprints of an average person’s daily food waste are: 124 g CO2 eq., 58 L of freshwater use, 0.36 m2 of cropland use, 2.90 g of nitrogen use and 0.48 g of phosphorus use.[71,72, [4,15473,,183,184][4]74,[153]75,[180]76,[77,78,18179,80,81,82,83,84,85][70][71][72][73]][74][75][76][77][78][79][80][81][82][83][84]
Reduce intake of salt Several dietary guidelines, health organizations and government policies recommend population-wide sodium restriction to prevent hypertension and related comorbidities such as heart failure. The reduction in blood pressure is clinically relevant in the hypertensive population, especially in the elderly and Black ethnicity populations. There is not enough scientific evidence to recommend salt reduction in the general population. Health policies should focus on the target population. [86,87
Food and vegetable biodiversity (agrobiodiversity) Agrobiodiversity: variety and variability of animals, plants and micro-organisms that are necessary for sustaining key functions of the agro-ecosystem. There is currently no agreed, standard way of measuring agrobiodiversity in diets, food production or genetic resources.

Indices include the Simpson’s diversity, Shannon’s diversity, and Dietary Species Richness. Beyond conventional measures, the Agrobiodiversity Index (ABD Index) is a method of measuring agrobiodiversity in a consistent, long-term manner to be applied across all pillars of sustainable food systems. The ABD Index assesses diversity in production, food markets, consumption, conservation, and seed systems.		,88,89,90][85][86][87][[88 Species richness and diversity scores are usually related to adequate levels of micronutrients and presented as a promising solution for food security issues. Furthermore, maintaining genetic diversity is key for agricultural crops and livestock to be able to adapt—naturally or with human intervention—to future needs and challenges and be resilient to disturbances.][89 [185184]]
,186,187,188,189,190,191,[185][186192,][187][188193,194][182][183]][189][190][191] Intake of dietary fiber Observational studies suggest a protective role of dietary fiber intake in colon cancer risk. Colon cancer (CC) is an entity with different molecular subtypes. Epidemiological studies can mask these subtypes. Few studies consider environmental and molecular factors together. Regarding CC patients, increased fiber intake does not reduce the risk of recurrence. [91,92,93,94
Land use Land use change: the acquisition of natural resources for human needs (croplands and pastures), often at the expense of degrading environmental conditions. According to FAOSTAT, in 2017, 50% of habitable land was used for agricultural purposes, of which 77% was used for animal feed. Land and soil degradation is a global challenge that may contribute to food insecurity, higher food prices and climate change in the near future. Overall, changing land use, high-yield cultivars and meat products are the main triggers of land deterioration.,95][90][91 [195][192]][92][93][94]
Reduce intake of palm oil (PO) PO contains a high amount of saturated fat (40–50% of total fat). Their low consumption has been proposed as a policy to reduce deaths due to CVD.
Land use: agricultural land required to produce crops for direct human consumption, as feed and for usage in industry and the energy sector, plus the area needed to produce the commodities’ packaging material. [196,197][193][194]
Human carrying capacity: persons fed per unit land area. [198][195
Value chain approach Value chains consist of involved actors (including public organizations and private firms) and the sequence of activities performed to bring a product from production to the consumer. Functioning supply chains require not only cooperation among supply chain actors (including farmers and between producers and other firms) but also rely on other supporting functions such as transport networks, standards and regulation enforcement, and credit markets. [219,220,221,222][218][219][220][221] Consumption of PO is associated with an increase in LDL cholesterol, but irrelevant clinically. Insignificant effects on fasting glucose and insulin. The studies to date do not establish strong evidence for or against PO consumption relating to cardiovascular disease risk and cardiovascular disease-specific mortality.
Production costs Local and organic agriculture is less productive per hectare and more vulnerable to climate patterns and pests. These risks elevate production costs and must be considered for producers to undertake modes of production beneficial for both the environment and producers’ long-term business survival (especially in low-income countries). [96,97,98,99,]
[223,224,225,226][222][223][224][225] 100,101 Land footprint: amount of land needed to produce food (grasslands, croplands used to produce feed crops, and croplands used to produce crops for human food). [199,200][196][197
Ethical and societal factors It is necessary to consider the impact on farmers’ livelihoods, especially for smaller operators and those in underdeveloped economies reliant on livestock production for income and wealth. ]
[219][218] Forest cover loss: areas of forest cover removed related to land use changes.
Demand side indicators Those affecting consumer food choices ,102][95][96][97][98][ [201][198]
Ecological footprint: biologically productive area people use for their consumption and pollution (i.e., crop-, grazing-, forest-, fish-, built-up and carbon-uptake land) to the biologically productive area available within a region or the world.
Availability  [202,203][199][200]
The availability of sufficient quantities of food of appropriate quality. [99][100][101]
Pesticide use Chemical footprint: all chemical substances released into the environment which may ultimately lead to ecotoxicity and human toxicity impacts. Pesticides used in the agricultural production phase are the main contributors to ecotoxicity and human toxicity episodes. The use of such chemicals is not commonly addressed by sustainability approaches. [149][148]
219][218]
Resilience (stability) Locally grown, organic, non-processed food lasts fewer days and must be more often purchased close to the production date. Such limitations must be accounted for to encourage the consumer to undertake dietary changes beneficial for the environment and guaranteeing the supply of food (especially in low-income countries). [224][223] Reduce intake of dietary fats (butter and margarine) Butter and margarine contain high amount of saturated fats. Saturated fats have been linked to high CVD risk. Butter consumption was weakly associated with all-cause mortality in prospective studies. A theoretical analysis suggests that substituting butter with tub margarine may be associated with reduced risk of myocardial infarction. Beef fat was more effective in reducing LDL-cholesterol as compared with butter according to randomized trials. The number of studies remains insufficient to conclude a cause–effect relationship between fats and CVD. [103,104,105]
Affordability A healthy/sustainable diet is more costly than a conventional diet. The environmental costs associated with a conventional diet are not high enough to compensate for the difference. [156,227,228,229,[226][227230][[102][103][104]
Reduce intake of whole dairy products Saturated fats from whole dairy derivatives have been associated with increased risk of chronic diseases including obesity, metabolic syndrome, T2DM, CVD, osteoporosis, and cancers. Intake of dairy products was associated with a neutral or reduced risk of T2DM and a reduced risk of CVD, particularly stroke. The evidence suggested a beneficial effect of dairy intake on bone mineral density but no association with risk of bone fracture. Among cancers, dairy intake was inversely associated with CRC, bladder cancer, gastric cancer, and breast cancer, and not associated with risk of pancreatic cancer, ovarian cancer, or lung cancer, while the evidence for prostate cancer risk was inconsistent. Consumption of dairy products was not associated with all-cause mortality. [106,107,108,[109,110,105111,112,] Nitrogen (N) application N footprint: total amount of N released into the environment during the food chain as emissions of nitrous oxide, nitric oxide, ammonia or molecular nitrogen to the atmosphere, or as nitrate or organic nitrogen to the hydrosphere before the food product is supplied to the consumer. In some studies, it has been considered equal to N use. A 50% increase in the N and P input to agricultural fields from 2010 levels will be required by 2050. N and P losses, agriculture intensification and dietary choices are responsible for eutrophication in many parts of the world and are endangering many freshwater and coastal ecosystems. [183,184,204,205][180][181][201][202]
155]][228][229]
Acceptability Beyond costs, consumer preferences are affected by a host of factors such as cultural values, family habits, religious beliefs, physical adaptations including those of digestibility and intolerance (different populations show different degrees of tolerance for certain foods), convenience (time to cook), etc., affecting what is acceptable for different consumers. [231,232,233][230][231][232][106][107][108][109][110][111113,][112114,][113115,][114116,][115117,][116118,][117119,]120,118][119]121,[122][120][121]
Reduce or suppress intake of red meat From the 1970s, epidemiological studies have suggested that cancer and CVD risks are linked to red meat. Saturated fat, heme
Access equality iron, N-nitroso compounds, and sialic acid have been implicated as causes of the increased risk. Income inequality increases the likelihood of severe food insecurity. The likelihood of being food insecure is higher for women than men in every continent.After multivariate adjustment for dietary and non-dietary risk factors, total, unprocessed, and processed red meat intake were each associated with a modestly higher risk of CVD.

Meats, meat products and meat derivatives are inconsistently classified or misclassified into food groups when dietary questionnaires are applied.

Studies examining the relation between the consumption or avoidance of meat and psychological health varied substantially in methodologic rigor, validity of interpretation, and confidence in results. Most studies, and especially the higher quality studies, showed that those who avoided meat consumption had significantly higher rates or risk of depression, anxiety, and/or self-harm behaviors.		 [ [217][123,124,125,126,127,128,129,130,131,132,133,134,135][122][123][124][125][126][127][128][129][130][131][132][133][134]
Dietary quality index An index combining the above criteria would allow the objective assessment of diet quality. Such indices would facilitate the implementation of dietary guidelines. From the 1990s, 50 more indices have been proposed based on nutrients, foods or combining the two. Most recent proposals include inflammatory or cardiovascular risk biomarkers.

The main limitations of these indices include: a non-standard methodology, “a priori” scoring, estimation of nutrient and biocompound intakes by questionnaires, failing to distinguish between some food types, difficulty in establishing a strong dose–effect relationship, inclusion of subrogated biomarkers, exclusion of different ethnic groups and phenotype/genotype profiles, poorly defined “lifestyle”, etc.

Some recommendations obtained from these indices are unrealistic since they propose food substitutions that nutritionally are not interchangeable.		 [136,137,138,[139,140,135141,142]][136][137][138][139][140][141]

Some studies analyzing the association between health and diet are based on preconceived concepts and established hypotheses that do not support the cause–effect results and do not take into consideration the sustainability of the assessed diets. A balanced and healthy diet should be based on available, accessible, affordable, safe and culturally acceptable food and allow guaranteeing socio-economic and environmental sustainability.

2.2. Environmentally Sustainable Diet

The two main approaches used to address the environmental sustainability of diets and food systems are life cycle analysis (LCA) and environmental footprints. LCA assesses the environmental impact of a product from resource extraction, manufacturing, and transport to use and end-of-life disposal [143]. Ideally, LCA studies cover every relevant environmental category. However, in the case of diet-related impact assessments, only a few environmental indicators are generally used to perform analyses. The most common and recurrent impact categories applied in these studies are climate change, freshwater use, land use, acidification, ecotoxicity, eutrophication, human toxicity, ionizing radiation, ozone depletion, particulate matter, photochemical ozone formation and resource depletion [144,145
N loss: nitrogen losses to the environment from agriculture (croplands and animal manure management).
[
206
]
[
203
]
216
Phosphorus (P) application
P footprint: total amount of P released into the environment as a result of food consumption. In some studies, it has been considered equal to P use.
[205,207][202][204]
] Water use and/or scarcity and pollution Green water footprint: volume of rainwater consumed during the production process.

Blue water footprint: volume of surface and groundwater consumed as a result of the production of a good or service.

Grey water footprint: the grey water footprint of a product is an indicator of freshwater pollution that can be associated with the production of a product over its full supply chain.		 Agriculture (including irrigation, livestock and aquaculture) accounts for approximately 70% of total freshwater use. Actual population growth and climate change scenarios are substantially increasing levels of water stress globally. Some of the most promising means to improve water use efficiency involve a combination of plant-based dietary choices and reducing food loss and waste. [184,208,209,210,211,212,213,214][181][205][206][207][208][209][210][211]
Water use efficiency: micronutrient output per liter consumptive water use. [215][212]
Blue water scarcity footprint: equivalent amount of water withdrawn from a waterbody at the global average level of stress. [157,199,216][156][196][213]
Green-blue water (GBW) scarcity index: ratio of GBW availability and water resource requirements for producing a country-specific 3000 kcal/cap/day model diet with 20% of the energy from animal products. [210,211][207][208]
Blue water scarcity: blue WF amounts in relation to local blue water availability. [213][210]
Recommendations from wealthier countries such as Europe include reducing the consumption of certain products, such as red meat and sugar, particularly by reducing excessive consumption, and increasing the consumption of fruits, vegetables, nuts and legumes [6,162]. Beyond these relevant global trends, a deeper understanding of the impacts of different production systems would be useful to improve and facilitate the decision-making. Furthermore, these methodologies do not generally consider aspects such as the rate of local/regional food consumption and seasonality, agrobiodiversity and organic/eco-friendly production and consumption [163].

Recommendations from wealthier countries such as Europe include reducing the consumption of certain products, such as red meat and sugar, particularly by reducing excessive consumption, and increasing the consumption of fruits, vegetables, nuts and legumes [6][214]. Beyond these relevant global trends, a deeper understanding of the impacts of different production systems would be useful to improve and facilitate the decision-making. Furthermore, these methodologies do not generally consider aspects such as the rate of local/regional food consumption and seasonality, agrobiodiversity and organic/eco-friendly production and consumption

 

References

  1. FAO; WHO. Sustainable Healthy Diets: Guiding Principles; Food and Agriculture Organization of the United Nations (FAO): Rome, Italy, 2019; p. 44.
  2. FAO. The Future of Food and Agriculture—Alternative Pathways to 2050; Food and Agriculture Organization of the United Nations (FAO): Rome, Italy, 2018; p. 224.
  3. Crippa, M.; Solazzo, E.; Guizzardi, D.; Monforti-Ferrario, F.; Tubiello, F.N.; Leip, A. Food systems are responsible for a third of global anthropogenic GHG emissions. Nat. Food 2021, 1–12.
  4. IPPC. Special Report on Climate Change and Land. An IPCC Special Report on Climate Change, Desertification, Land Degradation, Sustainable Land Management, Food Security, and Greenhouse Gas Fluxes in Terrestrial Ecosystems; Intergovernmental Panel on Climate Change: Dublin, Ireland, 2019; p. 874.
  5. IPBES, I. Summary for Policymakers of the Global Assessment Report on Biodiversity and Ecosystem Services; IPBES Secretariat: Bonn, Germany, 2019; p. 56.
  6. Willett, W.; Rockström, J.; Loken, B.; Springmann, M.; Lang, T.; Vermeulen, S.; Garnett, T.; Tilman, D.; DeClerck, F.; Wood, A.; et al. Food in the Anthropocene: The EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet 2019, 393, 447–492.
  7. Riley, H.; Buttriss, J.L. A UK public health perspective: What is a healthy sustainable diet? Nutr. Bull. 2011, 36, 426–431.
  8. Ministry of Health, Welfare and Sport. Guidelines for a Healthy Diet: The Ecological Perspective—Advisory Report; Health Council of the Netherlands: The Hague, The Netherlands, 2011; p. 84.
  9. Nordic Council of Ministers. Nordic Nutrition Recommendations 2012. Integrating Nutrition and Physical Activity, 5th ed.; Nordic Council of Ministers: Copenhagen, Denmark, 2014; p. 627.
  10. German Council for Sustainable Development. The Sustainable Shopping Basket. A Guide to Better Shopping; German Council for Sustainable Development: Berlin, Germany, 2013; p. 91.
  11. Ministry of Health of Brazil. Dietary Guidelines for the Brazilian Population; Secretariat of Health Care. Primary Health Care Department: Brasilia, Brazil, 2015; p. 152.
  12. Swedish Food Agency. The Swedish Dietary Guidelines: Find Your Way to Eat Greener, not too Much and be Active; Swedish Food Agency: Uppsala, Sweden, 2015; p. 28.
  13. Seed, B. Sustainability in the Qatar national dietary guidelines, among the first to incorporate sustainability principles. Public Health Nutr. 2015, 18, 2303–2310.
  14. Kesse-Guyot, E.; Chaltiel, D.; Wang, J.; Pointereau, P.; Langevin, B.; Allès, B.; Rebouillat, P.; Lairon, D.; Vidal, R.; Mariotti, F.; et al. Sustainability analysis of French dietary guidelines using multiple criteria. Nat. Sustain. 2020, 3, 377–385.
  15. Wrieden, W.; Halligan, J.; Goffe, L.; Barton, K.; Leinonen, I. Sustainable diets in the UK—Developing a systematic framework to assess the environmental impact, cost and nutritional quality of household food purchases. Sustainability 2019, 11, 4974.
  16. Reinhardt, S.L.; Boehm, R.; Blackstone, N.T.; El-Abbadi, N.H.; McNally Brandow, J.S.; Taylor, S.F.; DeLonge, M.S. Systematic review of dietary patterns and sustainability in the United States. Adv. Nutr. 2020, 11, 1016–1031.
  17. Wilson, N.; Cleghorn, C.L.; Cobiac, L.J.; Mizdrak, A.; Nghiem, N. Achieving healthy and sustainable diets: A review of the results of recent mathematical optimization studies. Adv. Nutr. 2019, 10, S389–S403.
  18. Tobi, R.C.A.; Harris, F.; Rana, R.; Brown, K.A.; Quaife, M.; Green, R. Sustainable diet dimensions. Comparing consumer preference for nutrition, environmental and social responsibility food labelling: A systematic review. Sustainability 2019, 11, 6575.
  19. Clune, S.; Crossin, E.; Verghese, K. Systematic review of greenhouse gas emissions for different fresh food categories. J. Clean. Prod. 2017, 140, 766–783.
  20. Hyland, J.J.; Henchion, M.; McCarthy, M.; McCarthy, S.N. The role of meat in strategies to achieve a sustainable diet lower in greenhouse gas emissions: A review. Meat Sci. 2017, 132, 189–195.
  21. Aleksandrowicz, L.; Green, R.; Joy, E.J.M.; Smith, P.; Haines, A. The impacts of dietary change on greenhouse gas emissions, land use, water use, and health: A systematic review. PLoS ONE 2016, 11, e0165797.
  22. Ferk, K.; Grujić, M.; Krešić, G. Shifting modern dietary patterns towards sustainable diets: Challenges and perspectives. Croat. J. Food Sci. Technol. 2018, 10, 261–269.
  23. Alsaffar, A.A. Sustainable diets: The interaction between food industry, nutrition, health and the environment. Food Sci. Technol. Int. 2016, 22, 102–111.
  24. Ridoutt, B.G.; Hendrie, G.A.; Noakes, M. Dietary strategies to reduce environmental impact: A critical review of the evidence base. Adv. Nutr. 2017, 8, 933–946.
  25. Auestad, N.; Fulgoni, V.L. What current literature tells us about sustainable diets: Emerging research linking dietary patterns, environmental sustainability, and economics. Adv. Nutr. 2015, 6, 19–36.
  26. Nelson, M.E.; Hamm, M.W.; Hu, F.B.; Abrams, S.A.; Griffin, T.S. Alignment of healthy dietary patterns and environmental sustainability: A systematic review. Adv. Nutr. 2016, 7, 1005–1025.
  27. Jones, A.D.; Hoey, L.; Blesh, J.; Miller, L.; Green, A.; Shapiro, L.F. A systematic review of the measurement of sustainable diets. Adv. Nutr. 2016, 7, 641–664.
  28. Eme, P.E.; Douwes, J.; Kim, N.; Foliaki, S.; Burlingame, B. Review of methodologies for assessing sustainable diets and potential for development of harmonised indicators. Int. J. Environ. Res. Public. Health 2019, 16, 1184.
  29. Martinelli, S.S.; Cavalli, S.B.; Martinelli, S.S.; Cavalli, S.B. Healthy and sustainable diet: A narrative review of the challenges and perspectives. Ciênc. Saúde Coletiva 2019, 24, 4251–4262.
  30. Bhushan, A.; Fondell, E.; Ascherio, A.; Yuan, C.; Grodstein, F.; Willett, W. Adherence to Mediterranean diet and subjective cognitive function in men. Eur. J. Epidemiol. 2018, 33, 223–234.
  31. Henríquez Sánchez, P.; Ruano, C.; de Irala, J.; Ruiz-Canela, M.; Martínez-González, M.A.; Sánchez-Villegas, A. Adherence to the Mediterranean diet and quality of life in the SUN Project. Eur. J. Clin. Nutr. 2012, 66, 360–368.
  32. Morris, M.C.; Tangney, C.C.; Wang, Y.; Sacks, F.M.; Bennett, D.A.; Aggarwal, N.T. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement. J. Alzheimers Assoc. 2015, 11, 1007–1014.
  33. Draper, A.; Lewis, J.; Malhotra, N.; Wheeler, L.E. The energy and nutrient intakes of different types of vegetarian: A case for supplements? Br. J. Nutr. 1993, 69, 3–19.
  34. Elorinne, A.-L.; Alfthan, G.; Erlund, I.; Kivimäki, H.; Paju, A.; Salminen, I.; Turpeinen, U.; Voutilainen, S.; Laakso, J. Food and nutrient intake and nutritional status of Finnish vegans and non-vegetarians. PLoS ONE 2016, 11.
  35. Janelle, K.C.; Barr, S.I. Nutrient intakes and eating behavior see of vegetarian and nonvegetarian women. J. Am. Diet. Assoc. 1995, 95, 180–189.
  36. Kristensen, N.B.; Madsen, M.L.; Hansen, T.H.; Allin, K.H.; Hoppe, C.; Fagt, S.; Lausten, M.S.; Gøbel, R.J.; Vestergaard, H.; Hansen, T.; et al. Intake of macro- and micronutrients in Danish vegans. Nutr. J. 2015, 14.
  37. Larsson, C.L.; Johansson, G.K. Young Swedish vegans have different sources of nutrients than young omnivores. J. Am. Diet. Assoc. 2005, 105, 1438–1441.
  38. Schüpbach, R.; Wegmüller, R.; Berguerand, C.; Bui, M.; Herter-Aeberli, I. Micronutrient status and intake in omnivores, vegetarians and vegans in Switzerland. Eur. J. Nutr. 2017, 56, 283–293.
  39. Sobiecki, J.G.; Appleby, P.N.; Bradbury, K.E.; Key, T.J. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: Results from the European Prospective Investigation into Cancer and Nutrition–Oxford study. Nutr. Res. 2016, 36, 464–477.
  40. Waldmann, A.; Koschizke, J.W.; Leitzmann, C.; Hahn, A. Dietary intakes and lifestyle factors of a vegan population in Germany: Results from the German Vegan Study. Eur. J. Clin. Nutr. 2003, 57, 947–955.
  41. Della Corte, K.W.; Perrar, I.; Penczynski, K.J.; Schwingshackl, L.; Herder, C.; Buyken, A.E. Effect of dietary sugar intake on biomarkers of subclinical inflammation: A systematic review and meta-analysis of intervention studies. Nutrients 2018, 10, 606.
  42. Erickson, J.; Sadeghirad, B.; Lytvyn, L.; Slavin, J.; Johnston, B.C. The scientific basis of guideline recommendations on sugar intake. Ann. Intern. Med. 2016, 166, 257–267.
  43. Khan, T.A.; Sievenpiper, J.L. Controversies about sugars: Results from systematic reviews and meta-analyses on obesity, cardiometabolic disease and diabetes. Eur. J. Nutr. 2016, 55, 25–43.
  44. Louie, J.C.Y.; Tapsell, L.C. Association between intake of total vs added sugar on diet quality: A systematic review. Nutr. Rev. 2015, 73, 837–857.
  45. Schwingshackl, L.; Neuenschwander, M.; Hoffmann, G.; Buyken, A.E.; Schlesinger, S. Dietary sugars and cardiometabolic risk factors: A network meta-analysis on isocaloric substitution interventions. Am. J. Clin. Nutr. 2020, 111, 187–196.
  46. Harcombe, Z.; Baker, J.S.; DiNicolantonio, J.J.; Grace, F.; Davies, B. Evidence from randomised controlled trials does not support current dietary fat guidelines: A systematic review and meta-analysis. Open Heart 2016, 3.
  47. Harcombe, Z.; Baker, J.S.; Davies, B. Evidence from prospective cohort studies does not support current dietary fat guidelines: A systematic review and meta-analysis. Br. J. Sports Med. 2017, 51, 1743–1749.
  48. Hooper, L.; Abdelhamid, A.; Moore, H.J.; Douthwaite, W.; Skeaff, C.M.; Summerbell, C.D. Effect of reducing total fat intake on body weight: Systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ 2012, 345.
  49. Makarewicz-Wujec, M.; Dworakowska, A.; Kozłowska-Wojciechowska, M. Replacement of saturated and trans-fatty acids in the diet v. CVD risk in the light of the most recent studies. Public Health Nutr. 2018, 21, 2291–2300.
  50. Praagman, J.; Beulens, J.W.; Alssema, M.; Zock, P.L.; Wanders, A.J.; Sluijs, I.; van der Schouw, Y.T. The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition–Netherlands cohort. Am. J. Clin. Nutr. 2016, 103, 356–365.
  51. Ramsden, C.E.; Zamora, D.; Majchrzak-Hong, S.; Faurot, K.R.; Broste, S.K.; Frantz, R.P.; Davis, J.M.; Ringel, A.; Suchindran, C.M.; Hibbeln, J.R. Re-evaluation of the traditional diet-heart hypothesis: Analysis of recovered data from Minnesota Coronary Experiment (1968-73). BMJ 2016, 353.
  52. Yang, W.-S.; Chen, P.-C.; Hsu, H.-C.; Su, T.-C.; Lin, H.-J.; Chen, M.-F.; Lee, Y.-T.; Chien, K.-L. Differential effects of saturated fatty acids on the risk of metabolic syndrome: A matched case-control and meta-analysis study. Metabolism 2018, 83, 42–49.
  53. Zhu, Y.; Bo, Y.; Liu, Y. Dietary total fat, fatty acids intake, and risk of cardiovascular disease: A dose-response meta-analysis of cohort studies. Lipids Health Dis. 2019, 18.
  54. Enns, J.E.; Yeganeh, A.; Zarychanski, R.; Abou-Setta, A.M.; Friesen, C.; Zahradka, P.; Taylor, C.G. The impact of omega-3 polyunsaturated fatty acid supplementation on the incidence of cardiovascular events and complications in peripheral arterial disease: A systematic review and meta-analysis. BMC Cardiovasc. Disord. 2014, 14, 70.
  55. Harris, W.S.; Del Gobbo, L.; Tintle, N.L. The Omega-3 Index and relative risk for coronary heart disease mortality: Estimation from 10 cohort studies. Atherosclerosis 2017, 262, 51–54.
  56. Harris, W.S. The Omega-6:Omega-3 ratio: A critical appraisal and possible successor. Prostaglandins Leukot. Essent. Fatty Acids 2018, 132, 34–40.
  57. Nelson, J.R.; Raskin, S. The eicosapentaenoic acid:arachidonic acid ratio and its clinical utility in cardiovascular disease. Postgrad. Med. 2019, 131, 268–277.
  58. Berger, S.; Raman, G.; Vishwanathan, R.; Jacques, P.F.; Johnson, E.J. Dietary cholesterol and cardiovascular disease: A systematic review and meta-analysis. Am. J. Clin. Nutr. 2015, 102, 276–294.
  59. Carson, J.A.S.; Lichtenstein, A.H.; Anderson, C.A.M.; Appel, L.J.; Kris-Etherton, P.M.; Meyer, K.A.; Kristina, P.; Polonsky, T.; Van Horn, L. Dietary cholesterol and cardiovascular risk: A science advisory from the American Heart Association. Circulation 2020, 141, e39–e53.
  60. Kapourchali, F.R.; Surendiran, G.; Goulet, A.; Moghadasian, M.H. The role of dietary cholesterol in lipoprotein metabolism and related metabolic abnormalities: A mini-review. Crit. Rev. Food Sci. Nutr. 2016, 56, 2408–2415.
  61. Soliman, G.A. Dietary cholesterol and the lack of evidence in cardiovascular disease. Nutrients 2018, 10, 780.
  62. Beynen, A.C.; Katan, M.B.; Van Zutphen, L.F.M. Hypo- and hyperresponders: Individual differences in the response of serum cholesterol concentration to changes in diet. Adv. Lipid Res. 1987, 22, 115–171.
  63. Herron, K.L.; Vega-Lopez, S.; Conde, K.; Ramjiganesh, T.; Shachter, N.S.; Fernandez, M.L. Men classified as hypo- or hyperresponders to dietary cholesterol feeding exhibit differences in lipoprotein metabolism. J. Nutr. 2003, 133, 1036–1042.
  64. Vincent, M.J.; Allen, B.; Palacios, O.M.; Haber, L.T.; Maki, K.C. Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterol. Am. J. Clin. Nutr. 2019, 109, 7–16.
  65. Drouin-Chartier, J.-P.; Chen, S.; Li, Y.; Schwab, A.L.; Stampfer, M.J.; Sacks, F.M.; Rosner, B.; Willett, W.C.; Hu, F.B.; Bhupathiraju, S.N. Egg consumption and risk of cardiovascular disease: Three large prospective US cohort studies, systematic review, and updated meta-analysis. BMJ 2020, 368.
  66. Rong, Y.; Chen, L.; Zhu, T.; Song, Y.; Yu, M.; Shan, Z.; Sands, A.; Hu, F.B.; Liu, L. Egg consumption and risk of coronary heart disease and stroke: Dose-response meta-analysis of prospective cohort studies. BMJ 2013, 346.
  67. Rouhani, M.H.; Rashidi-Pourfard, N.; Salehi-Abargouei, A.; Karimi, M.; Haghighatdoost, F. Effects of egg consumption on blood lipids: A systematic review and meta-analysis of randomized clinical trials. J. Am. Coll. Nutr. 2018, 37, 99–110.
  68. Wang, M.X.; Wong, C.H.; Kim, J.E. Impact of whole egg intake on blood pressure, lipids and lipoproteins in middle-aged and older population: A systematic review and meta-analysis of randomized controlled trials. Nutr. Metab. Cardiovasc. Dis. 2019, 29, 653–664.
  69. Xu, L.; Lam, T.H.; Jiang, C.Q.; Zhang, W.S.; Zhu, F.; Jin, Y.L.; Woo, J.; Cheng, K.K.; Thomas, G.N. Egg consumption and the risk of cardiovascular disease and all-cause mortality: Guangzhou Biobank Cohort Study and meta-analyses. Eur. J. Nutr. 2019, 58, 785–796.
  70. Richter, C.K.; Skulas-Ray, A.C.; Champagne, C.M.; Kris-Etherton, P.M. Plant protein and animal proteins: Do they differentially affect cardiovascular disease risk? Adv. Nutr. 2015, 6, 712–728.
  71. Campbell, W.W. Animal-based and plant-based protein-rich foods and cardiovascular health: A complex conundrum. Am. J. Clin. Nutr. 2019, 110, 8–9.
  72. Petersen, K.S.; Flock, M.R.; Richter, C.K.; Mukherjea, R.; Slavin, J.L.; Kris-Etherton, P.M. Healthy dietary patterns for preventing cardiometabolic disease: The role of plant-based foods and animal products. Curr. Dev. Nutr. 2017, 1.
  73. Wolfe, R.R.; Baum, J.I.; Starck, C.; Moughan, P.J. Factors contributing to the selection of dietary protein food sources. Clin. Nutr. 2018, 37, 130–138.
  74. Wolfe, R.R.; Cifelli, A.M.; Kostas, G.; Kim, I.-Y. Optimizing protein intake in adults: Interpretation and application of the recommended dietary allowance compared with the acceptable macronutrient distribution range. Adv. Nutr. 2017, 8, 266–275.
  75. Wallace, T.C.; Frankenfeld, C.L. Dietary protein intake above the current RDA and bone health: A systematic review and meta-analysis. J. Am. Coll. Nutr. 2017, 36, 481–496.
  76. Shams-White, M.M.; Chung, M.; Fu, Z.; Insogna, K.L.; Karlsen, M.C.; LeBoff, M.S.; Shapses, S.A.; Sackey, J.; Shi, J.; Wallace, T.C.; et al. Animal versus plant protein and adult bone health: A systematic review and meta-analysis from the National Osteoporosis Foundation. PLoS ONE 2018, 13, e0192459.
  77. Naghshi, S.; Sadeghi, O.; Willett, W.C.; Esmaillzadeh, A. Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: Systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2020, 370.
  78. Groenendijk, I.; den Boeft, L.; van Loon, L.J.C.; de Groot, L.C.P.G.M. High versus low dietary protein intake and bone health in older adults: A systematic review and meta-analysis. Comput. Struct. Biotechnol. J. 2019, 17, 1101–1112.
  79. Devries, M.C.; Sithamparapillai, A.; Brimble, K.S.; Banfield, L.; Morton, R.W.; Phillips, S.M. Changes in kidney function do not differ between healthy adults consuming higher- compared with lower- or normal-protein diets: A systematic review and meta-analysis. J. Nutr. 2018, 148, 1760–1775.
  80. Qi, X.-X.; Shen, P. Associations of dietary protein intake with all-cause, cardiovascular disease, and cancer mortality: A systematic review and meta-analysis of cohort studies. Nutr. Metab. Cardiovasc. Dis. 2020, 30, 1094–1105.
  81. Chen, Z.; Glisic, M.; Song, M.; Aliahmad, H.A.; Zhang, X.; Moumdjian, A.C.; Gonzalez-Jaramillo, V.; van der Schaft, N.; Bramer, W.M.; Ikram, M.A.; et al. Dietary protein intake and all-cause and cause-specific mortality: Results from the Rotterdam Study and a meta-analysis of prospective cohort studies. Eur. J. Epidemiol. 2020, 35, 411–429.
  82. Landi, F.; Calvani, R.; Tosato, M.; Martone, A.M.; Ortolani, E.; Savera, G.; D’Angelo, E.; Sisto, A.; Marzetti, E. Protein intake and muscle health in old age: From biological plausibility to clinical evidence. Nutrients 2016, 8, 295.
  83. Schoenfeld, B.J.; Aragon, A.A. How much protein can the body use in a single meal for muscle-building? Implications for daily protein distribution. J. Int. Soc. Sports Nutr. 2018, 15.
  84. Hudson, J.L.; Bergia, R.E.; Campbell, W.W. Protein distribution and muscle-related outcomes: Does the evidence support the concept? Nutrients 2020, 12, 1441.
  85. DiNicolantonio, J.J.; Chatterjee, S.; O’Keefe, J.H. Dietary salt restriction in heart failure: Where is the evidence? Prog. Cardiovasc. Dis. 2016, 58, 401–406.
  86. Graudal, N. A radical sodium reduction policy is not supported by randomized controlled trials or observational studies: Grading the evidence. Am. J. Hypertens. 2016, 29, 543–548.
  87. Graudal, N.A.; Hubeck-Graudal, T.; Jurgens, G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst. Rev. 2017, 4, 1–310.
  88. Graudal, N.; Hubeck-Graudal, T.; Jürgens, G.; Taylor, R.S. Dose-response relation between dietary sodium and blood pressure: A meta-regression analysis of 133 randomized controlled trials. Am. J. Clin. Nutr. 2019, 109, 1273–1278.
  89. Huang, L.; Trieu, K.; Yoshimura, S.; Neal, B.; Woodward, M.; Campbell, N.R.C.; Li, Q.; Lackland, D.T.; Leung, A.A.; Anderson, C.A.M.; et al. Effect of dose and duration of reduction in dietary sodium on blood pressure levels: Systematic review and meta-analysis of randomised trials. BMJ 2020, 368.
  90. Gianfredi, V.; Salvatori, T.; Villarini, M.; Moretti, M.; Nucci, D.; Realdon, S. Is dietary fibre truly protective against colon cancer? A systematic review and meta-analysis. Int. J. Food Sci. Nutr. 2018, 69, 904–915.
  91. Theodoratou, E.; Timofeeva, M.; Li, X.; Meng, X.; Ioannidis, J.P.A. Nature, Nurture and cancer risks: Genetic and nutritional contributions to cancer. Annu. Rev. Nutr. 2017, 37, 293–320.
  92. Yang, T.; Li, X.; Montazeri, Z.; Little, J.; Farrington, S.M.; Ioannidis, J.P.A.; Dunlop, M.G.; Campbell, H.; Timofeeva, M.; Theodoratou, E. Gene–environment interactions and colorectal cancer risk: An umbrella review of systematic reviews and meta-analyses of observational studies. Int. J. Cancer 2019, 145, 2315–2329.
  93. Yao, Y.; Suo, T.; Andersson, R.; Cao, Y.; Wang, C.; Lu, J.; Chui, E. Dietary fibre for the prevention of recurrent colorectal adenomas and carcinomas. Cochrane Database Syst. Rev. 2017, 1, CD003430.
  94. Hughes, L.A.E.; Simons, C.C.J.M.; van den Brandt, P.A.; van Engeland, M.; Weijenberg, M.P. Lifestyle, diet, and colorectal cancer risk according to (epi)genetic instability: Current evidence and future directions of molecular pathological epidemiology. Curr. Colorectal Cancer Rep. 2017, 13, 455–469.
  95. Bronsky, J.; Campoy, C.; Embleton, N.; Fewtrell, M.; Mis, N.F.; Gerasimidis, K.; Hojsak, I.; Hulst, J.; Indrio, F.; Lapillonne, A.; et al. Palm oil and beta-palmitate in infant formula: A position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 2019, 68, 742–760.
  96. Fattore, E.; Bosetti, C.; Brighenti, F.; Agostoni, C.; Fattore, G. Palm oil and blood lipid–related markers of cardiovascular disease: A systematic review and meta-analysis of dietary intervention trials. Am. J. Clin. Nutr. 2014, 99, 1331–1350.
  97. Ismail, S.R.; Maarof, S.K.; Siedar Ali, S.; Ali, A. Systematic review of palm oil consumption and the risk of cardiovascular disease. PLoS ONE 2018, 13.
  98. Sun, Y.; Neelakantan, N.; Wu, Y.; Lote-Oke, R.; Pan, A.; van Dam, R.M. Palm oil consumption increases LDL cholesterol compared with vegetable oils low in saturated fat in a meta-analysis of clinical trials. J. Nutr. 2015, 145, 1549–1558.
  99. Voon, P.T.; Lee, S.T.; Ng, T.K.W.; Ng, Y.T.; Yong, X.S.; Lee, V.K.M.; Ong, A.S.H. Intake of palm olein and lipid status in healthy adults: A meta-analysis. Adv. Nutr. 2019, 10, 647–659.
  100. Wang, F.; Zhao, D.; Yang, Y.; Zhang, L. Effect of palm oil consumption on plasma lipid concentrations related to cardiovascular disease: A systematic review and meta-analysis. Asia Pac. J. Clin. Nutr. 2019, 28, 495–506.
  101. Zulkiply, S.H.; Balasubramaniam, V.; Abu Bakar, N.A.; Abd Rashed, A.; Ismail, S.R. Effects of palm oil consumption on biomarkers of glucose metabolism: A systematic review. PLoS ONE 2019, 14.
  102. Liu, Q.; Rossouw, J.E.; Roberts, M.B.; Liu, S.; Johnson, K.C.; Shikany, J.M.; Manson, J.E.; Tinker, L.F.; Eaton, C.B. Theoretical effects of substituting butter with margarine on risk of cardiovascular disease. Epidemiol. Camb. Mass 2017, 28, 145–156.
  103. Pimpin, L.; Wu, J.H.Y.; Haskelberg, H.; Del Gobbo, L.; Mozaffarian, D. Is butter back? A systematic review and meta-analysis of butter consumption and risk of cardiovascular disease, diabetes, and total mortality. PLoS ONE 2016, 11.
  104. Schwingshackl, L.; Bogensberger, B.; Benčič, A.; Knüppel, S.; Boeing, H.; Hoffmann, G. Effects of oils and solid fats on blood lipids: A systematic review and network meta-analysis. J. Lipid Res. 2018, 59, 1771–1782.
  105. Alexander, D.D.; Bylsma, L.C.; Vargas, A.J.; Cohen, S.S.; Doucette, A.; Mohamed, M.; Irvin, S.R.; Miller, P.E.; Watson, H.; Fryzek, J.P. Dairy consumption and CVD: A systematic review and meta-analysis. Br. J. Nutr. 2016, 115, 737–750.
  106. Cavero-Redondo, I.; Alvarez-Bueno, C.; Sotos-Prieto, M.; Gil, A.; Martinez-Vizcaino, V.; Ruiz, J.R. Milk and dairy product consumption and risk of mortality: An overview of systematic reviews and meta-analyses. Adv. Nutr. 2019, 10, S97–S104.
  107. Chen, G.-C.; Wang, Y.; Tong, X.; Szeto, I.M.Y.; Smit, G.; Li, Z.-N.; Qin, L.-Q. Cheese consumption and risk of cardiovascular disease: A meta-analysis of prospective studies. Eur. J. Nutr. 2017, 56, 2565–2575.
  108. De Goede, J.; Soedamah-Muthu, S.S.; Pan, A.; Gijsbers, L.; Geleijnse, J.M. Dairy consumption and risk of stroke: A systematic review and updated dose–response meta-analysis of prospective cohort studies. J. Am. Heart Assoc. Cardiovasc. Cerebrovasc. Dis. 2016, 5.
  109. Duarte, C.; Boccardi, V.; Andrade, P.A.; Lopes, A.C.S.; Jacques, P.F. Dairy versus other saturated fats source and cardiometabolic risk markers: Systematic review of randomized controlled trials. Crit. Rev. Food Sci. Nutr. 2021, 61, 450–461.
  110. Guo, J.; Astrup, A.; Lovegrove, J.A.; Gijsbers, L.; Givens, D.I.; Soedamah-Muthu, S.S. Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality: Dose–response meta-analysis of prospective cohort studies. Eur. J. Epidemiol. 2017, 32, 269–287.
  111. Hu, D.; Huang, J.; Wang, Y.; Zhang, D.; Qu, Y. Dairy foods and risk of stroke: A meta-analysis of prospective cohort studies. Nutr. Metab. Cardiovasc. Dis. 2014, 24, 460–469.
  112. Imamura, F.; Fretts, A.; Marklund, M.; Ardisson Korat, A.V.; Yang, W.-S.; Lankinen, M.; Qureshi, W.; Helmer, C.; Chen, T.-A.; Wong, K.; et al. Fatty acid biomarkers of dairy fat consumption and incidence of type 2 diabetes: A pooled analysis of prospective cohort studies. PLoS Med. 2018, 15.
  113. Jakobsen, M.U.; Trolle, E.; Outzen, M.; Mejborn, H.; Grønberg, M.G.; Lyndgaard, C.B.; Stockmarr, A.; Venø, S.K.; Bysted, A. Intake of dairy products and associations with major atherosclerotic cardiovascular diseases: A systematic review and meta-analysis of cohort studies. Sci. Rep. 2021, 11.
  114. Lee, M.; Lee, H.; Kim, J. Dairy food consumption is associated with a lower risk of the metabolic syndrome and its components: A systematic review and meta-analysis. Br. J. Nutr. 2018, 120, 373–384.
  115. Liang, J.; Zhou, Q.; Amakye, W.K.; Su, Y.; Zhang, Z. Biomarkers of dairy fat intake and risk of cardiovascular disease: A systematic review and meta analysis of prospective studies. Crit. Rev. Food Sci. Nutr. 2018, 58, 1122–1130.
  116. Lu, W.; Chen, H.; Niu, Y.; Wu, H.; Xia, D.; Wu, Y. Dairy products intake and cancer mortality risk: A meta-analysis of 11 population-based cohort studies. Nutr. J. 2016, 15.
  117. Mazidi, M.; Mikhailidis, D.P.; Sattar, N.; Howard, G.; Graham, I.; Banach, M. Consumption of dairy product and its association with total and cause specific mortality—A population-based cohort study and meta-analysis. Clin. Nutr. 2019, 38, 2833–2845.
  118. Naghshi, S.; Sadeghi, O.; Larijani, B.; Esmaillzadeh, A. High vs. low-fat dairy and milk differently affects the risk of all-cause, CVD, and cancer death: A systematic review and dose-response meta-analysis of prospective cohort studies. Crit. Rev. Food Sci. Nutr. 2021, 1–15.
  119. Nieman, K.M.; Anderson, B.D.; Cifelli, C.J. The effects of dairy product and dairy protein intake on inflammation: A systematic review of the literature. J. Am. Coll. Nutr. 2020, 1–12.
  120. O’Sullivan, T.A.; Schmidt, K.A.; Kratz, M. Whole-fat or reduced-fat dairy product intake, adiposity, and cardiometabolic health in children: A systematic review. Adv. Nutr. 2020, 11, 928–950.
  121. Zhang, K.; Chen, X.; Zhang, L.; Deng, Z. Fermented dairy foods intake and risk of cardiovascular diseases: A meta-analysis of cohort studies. Crit. Rev. Food Sci. Nutr. 2020, 60, 1189–1194.
  122. Al-Shaar, L.; Satija, A.; Wang, D.D.; Rimm, E.B.; Smith-Warner, S.A.; Stampfer, M.J.; Hu, F.B.; Willett, W.C. Red meat intake and risk of coronary heart disease among US men: Prospective cohort study. BMJ 2020, 371.
  123. Händel, M.N.; Cardoso, I.; Rasmussen, K.M.; Rohde, J.F.; Jacobsen, R.; Nielsen, S.M.; Christensen, R.; Heitmann, B.L. Processed meat intake and chronic disease morbidity and mortality: An overview of systematic reviews and meta-analyses. PLoS ONE 2019, 14, e0223883.
  124. Knuppel, A.; Papier, K.; Fensom, G.K.; Appleby, P.N.; Schmidt, J.A.; Tong, T.Y.N.; Travis, R.C.; Key, T.J.; Perez-Cornago, A. Meat intake and cancer risk: Prospective analyses in UK Biobank. Int. J. Epidemiol. 2020.
  125. Simpson, E.J.; Clark, M.; Razak, A.A.; Salter, A. The impact of reduced red and processed meat consumption on cardiovascular risk factors; An intervention trial in healthy volunteers. Food Funct. 2019, 10, 6690–6698.
  126. Qian, F.; Riddle, M.C.; Wylie-Rosett, J.; Hu, F.B. Red and processed meats and health risks: How strong is the evidence? Diabetes Care 2020, 43, 265–271.
  127. Zeraatkar, D.; Han, M.A.; Guyatt, G.H.; Vernooij, R.W.M.; El Dib, R.; Cheung, K.; Milio, K.; Zworth, M.; Bartoszko, J.J.; Valli, C.; et al. Red and processed meat consumption and risk for all-cause mortality and cardiometabolic outcomes. Ann. Intern. Med. 2019, 171, 703–710.
  128. Vernooij, R.W.M.; Zeraatkar, D.; Han, M.A.; El Dib, R.; Zworth, M.; Milio, K.; Sit, D.; Lee, Y.; Gomaa, H.; Valli, C.; et al. Patterns of red and processed meat consumption and risk for cardiometabolic and cancer outcomes. Ann. Intern. Med. 2019, 171, 732–741.
  129. Zhao, Z.; Yin, Z.; Zhao, Q. Red and processed meat consumption and gastric cancer risk: A systematic review and meta-analysis. Oncotarget 2017, 8, 30563–30575.
  130. Dobersek, U.; Wy, G.; Adkins, J.; Altmeyer, S.; Krout, K.; Lavie, C.J.; Archer, E. Meat and mental health: A systematic review of meat abstention and depression, anxiety, and related phenomena. Crit. Rev. Food Sci. Nutr. 2021, 61, 622–635.
  131. Nucci, D.; Fatigoni, C.; Amerio, A.; Odone, A.; Gianfredi, V. Red and processed meat consumption and risk of depression: A systematic review and meta-analysis. Int. J. Environ. Res. Public. Health 2020, 17, 6686.
  132. Zhang, Y.; Yang, Y.; Xie, M.; Ding, X.; Li, H.; Liu, Z.; Peng, S. Is meat consumption associated with depression? A meta-analysis of observational studies. BMC Psychiatry 2017, 17, 409.
  133. Gifford, C.L.; O’Connor, L.E.; Campbell, W.W.; Woerner, D.R.; Belk, K.E. Broad and inconsistent muscle food classification is problematic for dietary guidance in the U.S. Nutrients 2017, 9, 1027.
  134. O’Connor, L.E.; Gifford, C.L.; Woerner, D.R.; Sharp, J.L.; Belk, K.E.; Campbell, W.W. Dietary meat categories and descriptions in chronic disease research are substantively different within and between experimental and observational studies: A systematic review and landscape analysis. Adv. Nutr. 2020, 11, 41–51.
  135. Burggraf, C.; Teuber, R.; Brosig, S.; Meier, T. Review of a priori dietary quality indices in relation to their construction criteria. Nutr. Rev. 2018, 76, 747–764.
  136. Wang, J.; Masters, W.A.; Bai, Y.; Mozaffarian, D.; Naumova, E.N.; Singh, G.M. The International Diet-Health Index: A novel tool to evaluate diet quality for cardiometabolic health across countries. BMJ Glob. Health 2020, 5, e002120.
  137. Potter, J.; Brown, L.; Williams, R.L.; Byles, J.; Collins, C.E. Diet quality and cancer outcomes in adults: A systematic review of epidemiological studies. Int. J. Mol. Sci. 2016, 17, 1052.
  138. Johnston, E.A.; Petersen, K.S.; Beasley, J.M.; Krussig, T.; Mitchell, D.C.; Van Horn, L.V.; Weiss, R.; Kris-Etherton, P.M. Relative validity and reliability of a diet risk score (DRS) for clinical practice. BMJ Nutr. Prev. Health 2020, 3, 263–269.
  139. Milajerdi, A.; Namazi, N.; Larijani, B.; Azadbakht, L. The association of dietary quality indices and cancer mortality: A Systematic review and meta-analysis of cohort studies. Nutr. Cancer 2018, 70, 1091–1105.
  140. Aljuraiban, G.S.; Gibson, R.; Oude Griep, L.M.; Okuda, N.; Steffen, L.M.; Van Horn, L.; Chan, Q. Perspective: The application of a priori diet quality scores to cardiovascular disease risk—A critical evaluation of current scoring systems. Adv. Nutr. 2020, 11, 10–24.
  141. Miller, V.; Webb, P.; Micha, R.; Mozaffarian, D. Defining diet quality: A synthesis of dietary quality metrics and their validity for the double burden of malnutrition. Lancet Planet. Health 2020, 4, e352–e370.
  142. Rose, D.; Heller, M.C.; Roberto, C.A. Position of the society for nutrition education and behavior: The importance of including environmental sustainability in dietary guidance. J. Nutr. Educ. Behav. 2019, 51, 3–15.e1.
  143. Behrens, P.; Jong, J.C.K.; Bosker, T.; Rodrigues, J.F.D.; de Koning, A.; Tukker, A. Evaluating the environmental impacts of dietary recommendations. Proc. Natl. Acad. Sci. USA 2017, 114, 13412–13417.
  144. Blackstone, N.T.; El-Abbadi, N.H.; McCabe, M.S.; Griffin, T.S.; Nelson, M.E. Linking sustainability to the healthy eating patterns of the Dietary Guidelines for Americans: A modelling study. Lancet Planet. Health 2018, 2, e344–e352.
  145. Coelho, C.R.V.; Pernollet, F.; van der Werf, H.M.G. Environmental life cycle assessment of diets with improved omega-3 fatty acid profiles. PLoS ONE 2016, 11, e0160397.
  146. Kim, D.; Parajuli, R.; Thoma, G.J. Life cycle assessment of dietary patterns in the United States: A full food supply chain perspective. Sustainability 2020, 12, 1586.
  147. Liao, X.; Gerichhausen, M.J.W.; Bengoa, X.; Rigarlsford, G.; Beverloo, R.H.; Bruggeman, Y.; Rossi, V. Large-scale regionalised LCA shows that plant-based fat spreads have a lower climate, land occupation and water scarcity impact than dairy butter. Int. J. Life Cycle Assess. 2020, 25, 1043–1058.
  148. Notarnicola, B.; Tassielli, G.; Renzulli, P.A.; Castellani, V.; Sala, S. Environmental impacts of food consumption in Europe. J. Clean. Prod. 2017, 140, 753–765.
  149. Smetana, S.; Schmitt, E.; Mathys, A. Sustainable use of Hermetia illucens insect biomass for feed and food: Attributional and consequential life cycle assessment. Resour. Conserv. Recycl. 2019, 144, 285–296.
  150. Hoekstra, A.Y.; Wiedmann, T.O. Humanity’s unsustainable environmental footprint. Science 2014, 344, 1114–1117.
  151. Vanham, D.; Leip, A.; Galli, A.; Kastner, T.; Bruckner, M.; Uwizeye, A.; van Dijk, K.; Ercin, E.; Dalin, C.; Brandão, M.; et al. Environmental footprint family to address local to planetary sustainability and deliver on the SDGs. Sci. Total Environ. 2019, 693, 133642.
  152. Borsato, E.; Tarolli, P.; Marinello, F. Sustainable patterns of main agricultural products combining different footprint parameters. J. Clean. Prod. 2018, 179, 357–367.
  153. Chaudhary, A.; Gustafson, D.; Mathys, A. Multi-indicator sustainability assessment of global food systems. Nat. Commun. 2018, 9, 848.
  154. Chaudhary, A.; Krishna, V. Country-specific sustainable diets using optimization algorithm. Environ. Sci. Technol. 2019, 53, 7694–7703.
  155. Chen, C.; Chaudhary, A.; Mathys, A. Dietary change scenarios and implications for environmental, nutrition, human health and economic dimensions of food sustainability. Nutrients 2019, 11, 856.
  156. Hess, T.; Chatterton, J.; Daccache, A.; Williams, A. The impact of changing food choices on the blue water scarcity footprint and greenhouse gas emissions of the British diet: The example of potato, pasta and rice. J. Clean. Prod. 2016, 112, 4558–4568.
  157. Sáez-Almendros, S.; Obrador, B.; Bach-Faig, A.; Serra-Majem, L. Environmental footprints of Mediterranean versus Western dietary patterns: Beyond the health benefits of the Mediterranean diet. Environ. Health 2013, 12, 118.
  158. Springmann, M.; Spajic, L.; Clark, M.A.; Poore, J.; Herforth, A.; Webb, P.; Rayner, M.; Scarborough, P. The healthiness and sustainability of national and global food based dietary guidelines: Modelling study. BMJ 2020, 370.
  159. Springmann, M.; Wiebe, K.; Mason-D’Croz, D.; Sulser, T.B.; Rayner, M.; Scarborough, P. Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: A global modelling analysis with country-level detail. Lancet Planet. Health 2018, 2, e451–e461.
  160. Naja, F.; Hwalla, N.; El Zouhbi, A.; Abbas, N.; Chamieh, M.C.; Nasreddine, L.; Jomaa, L. Changes in environmental footprints associated with dietary intake of Lebanese adolescents between the years 1997 and 2009. Sustainability 2020, 12, 4519.
  161. Chaudhary, A.; Mooers, A.O. Terrestrial vertebrate biodiversity loss under future global land use change scenarios. Sustainability 2018, 10, 2764.
  162. Crist, E.; Mora, C.; Engelman, R. The interaction of human population, food production, and biodiversity protection. Science 2017, 356, 260–264.
  163. FAO. Sustainable Diets and Biodiversity—Directions and Solutions for Policy, Research and Actions. In Proceedings of the International Scientific Symposium; Food and Agriculture Organization of the United Nations (FAO): Rome, Italy, 2012; p. 309.
  164. González-Chang, M.; Wratten, S.D.; Shields, M.W.; Costanza, R.; Dainese, M.; Gurr, G.M.; Johnson, J.; Karp, D.S.; Ketelaar, J.W.; Nboyine, J.; et al. Understanding the pathways from biodiversity to agro-ecological outcomes: A new, interactive approach. Agric. Ecosyst. Environ. 2020, 301, 107053.
  165. Hawkins, I.W. Promoting Biodiversity in Food Systems. A Textbook in Tribology, 2nd ed.; CRC Press: Boca Raton, FL, USA, 2018; ISBN 978-1-315-21264-7.
  166. Reynolds, C.J. Energy embodied in household cookery: The missing part of a sustainable food system? Part 2: A life cycle assessment of roast beef and Yorkshire pudding. Energy Procedia 2017, 123, 228–234.
  167. Aston, L.M.; Smith, J.N.; Powles, J.W. Impact of a reduced red and processed meat dietary pattern on disease risks and greenhouse gas emissions in the UK: A modelling study. BMJ Open 2012, 2, e001072.
  168. Eustachio Colombo, P.; Patterson, E.; Lindroos, A.K.; Parlesak, A.; Elinder, L.S. Sustainable and acceptable school meals through optimization analysis: An intervention study. Nutr. J. 2020, 19, 61.
  169. Hendrie, G.A.; Ridoutt, B.G.; Wiedmann, T.O.; Noakes, M. Greenhouse gas emissions and the Australian diet—comparing dietary recommendations with average intakes. Nutrients 2014, 6, 289–303.
  170. Hendrie, G.A.; Baird, D.; Ridoutt, B.; Hadjikakou, M.; Noakes, M. Overconsumption of energy and excessive discretionary food intake inflates dietary greenhouse gas emissions in Australia. Nutrients 2016, 8, 690.
  171. Horgan, G.W.; Perrin, A.; Whybrow, S.; Macdiarmid, J.I. Achieving dietary recommendations and reducing greenhouse gas emissions: Modelling diets to minimise the change from current intakes. Int. J. Behav. Nutr. Phys. Act. 2016, 13, 46.
  172. Masset, G.; Vieux, F.; Verger, E.O.; Soler, L.-G.; Touazi, D.; Darmon, N. Reducing energy intake and energy density for a sustainable diet: A study based on self-selected diets in French adults. Am. J. Clin. Nutr. 2014, 99, 1460–1469.
  173. Reynolds, C.J.; Horgan, G.W.; Whybrow, S.; Macdiarmid, J.I. Healthy and sustainable diets that meet greenhouse gas emission reduction targets and are affordable for different income groups in the UK. Public Health Nutr. 2019, 22, 1503–1517.
  174. Springmann, M.; Godfray, H.C.J.; Rayner, M.; Scarborough, P. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc. Natl. Acad. Sci. USA 2016, 113, 4146–4153.
  175. Van de Kamp, M.E.; van Dooren, C.; Hollander, A.; Geurts, M.; Brink, E.J.; van Rossum, C.; Biesbroek, S.; de Valk, E.; Toxopeus, I.B.; Temme, E.H.M. Healthy diets with reduced environmental impact?—The greenhouse gas emissions of various diets adhering to the Dutch food based dietary guidelines. Food Res. Int. 2018, 104, 14–24.
  176. Vieux, F.; Darmon, N.; Touazi, D.; Soler, L.G. Greenhouse gas emissions of self-selected individual diets in France: Changing the diet structure or consuming less? Ecol. Econ. 2012, 75, 91–101.
  177. Vieux, F.; Soler, L.-G.; Touazi, D.; Darmon, N. High nutritional quality is not associated with low greenhouse gas emissions in self-selected diets of French adults. Am. J. Clin. Nutr. 2013, 97, 569–583.
  178. Ferrari, M.; Benvenuti, L.; Rossi, L.; De Santis, A.; Sette, S.; Martone, D.; Piccinelli, R.; Le Donne, C.; Leclercq, C.; Turrini, A. Could dietary goals and climate change mitigation be achieved through optimized diet? The experience of modeling the national food consumption data in Italy. Front. Nutr. 2020, 7.
  179. González-García, S.; Esteve-Llorens, X.; Moreira, M.T.; Feijoo, G. Carbon footprint and nutritional quality of different human dietary choices. Sci. Total Environ. 2018, 644, 77–94.
  180. Chen, C.; Chaudhary, A.; Mathys, A. Nutritional and environmental losses embedded in global food waste. Resour. Conserv. Recycl. 2020, 160, 104912.
  181. Vanham, D.; Bouraoui, F.; Leip, A.; Grizzetti, B.; Bidoglio, G. Lost water and nitrogen resources due to EU consumer food waste. Environ. Res. Lett. 2015, 10, 084008.
  182. Blanco-Salas, J.; Gutiérrez-García, L.; Labrador-Moreno, J.; Ruiz-Téllez, T. Wild plants potentially used in human food in the protected area “Sierra Grande de Hornachos” of Extremadura (Spain). Sustainability 2019, 11, 456.
  183. Durazzo, A. The close linkage between nutrition and environment through biodiversity and sustainability: Local foods, traditional recipes, and sustainable diets. Sustainability 2019, 11, 2876.
  184. Jones, A.D.; Creed-Kanashiro, H.; Zimmerer, K.S.; de Haan, S.; Carrasco, M.; Meza, K.; Cruz-Garcia, G.S.; Tello, M.; Plasencia Amaya, F.; Marin, R.M.; et al. Farm-level agricultural biodiversity in the peruvian Andes is associated with greater odds of women achieving a minimally diverse and micronutrient adequate diet. J. Nutr. 2018, 148, 1625–1637.
  185. Gruber, K. Agrobiodiversity: The living library. Nature 2017, 544, S8–S10.
  186. Martin, G.; Barth, K.; Benoit, M.; Brock, C.; Destruel, M.; Dumont, B.; Grillot, M.; Hübner, S.; Magne, M.-A.; Moerman, M.; et al. Potential of multi-species livestock farming to improve the sustainability of livestock farms: A review. Agric. Syst. 2020, 181, 102821.
  187. ELN-FA. Functional AgrobiodiversityNature Serving Europe’s Farmers. ECNC-European Centre for Nature Conservation: Tilburg, The Netherlands, 2012; p. 60.
  188. Ray, A.; Ray, R.; Sreevidya, E.A. How many wild edible plants do we eat—Their diversity, use, and implications for sustainable food system: An exploratory analysis in India. Front. Sustain. Food Syst. 2020, 4.
  189. Recchia, L.; Cappelli, A.; Cini, E.; Garbati Pegna, F.; Boncinelli, P. Environmental sustainability of pasta production chains: An integrated approach for comparing local and global chains. Resources 2019, 8, 56.
  190. Sibhatu, K.T.; Qaim, M. Farm production diversity and dietary quality: Linkages and measurement issues. Food Secur. 2018, 10, 47–59.
  191. Zimmerer, K.S.; de Haan, S.; Jones, A.D.; Creed-Kanashiro, H.; Tello, M.; Carrasco, M.; Meza, K.; Plasencia Amaya, F.; Cruz-Garcia, G.S.; Tubbeh, R.; et al. The biodiversity of food and agriculture (Agrobiodiversity) in the anthropocene: Research advances and conceptual framework. Anthropocene 2019, 25, 100192.
  192. Foley, J.A.; DeFries, R.; Asner, G.P.; Barford, C.; Bonan, G.; Carpenter, S.R.; Chapin, F.S.; Coe, M.T.; Daily, G.C.; Gibbs, H.K.; et al. Global consequences of land use. Science 2005, 309, 570–574.
  193. Meier, T.; Christen, O.; Semler, E.; Jahreis, G.; Voget-Kleschin, L.; Schrode, A.; Artmann, M. Balancing virtual land imports by a shift in the diet. Using a land balance approach to assess the sustainability of food consumption. Germany as an example. Appetite 2014, 74, 20–34.
  194. Rizvi, S.; Pagnutti, C.; Fraser, E.; Bauch, C.T.; Anand, M. Global land use implications of dietary trends. PLoS ONE 2018, 13, e0200781.
  195. Peters, C.J.; Picardy, J.; Darrouzet-Nardi, A.F.; Wilkins, J.L.; Griffin, T.S.; Fick, G.W. Carrying capacity of U.S. agricultural land: Ten diet scenarios. Elem. Sci. Anthr. 2016, 4, 000116.
  196. Laroche, P.C.S.J.; Schulp, C.J.E.; Kastner, T.; Verburg, P.H. Telecoupled environmental impacts of current and alternative Western diets. Glob. Environ. Chang. 2020, 62, 102066.
  197. De Ruiter, H.; Macdiarmid, J.I.; Matthews, R.B.; Kastner, T.; Lynd, L.R.; Smith, P. Total global agricultural land footprint associated with UK food supply 1986–2011. Glob. Environ. Chang. 2017, 43, 72–81.
  198. Galway, L.P.; Acharya, Y.; Jones, A.D. Deforestation and child diet diversity: A geospatial analysis of 15 Sub-Saharan African countries. Health Place 2018, 51, 78–88.
  199. Collins, A.; Fairchild, R. Sustainable food consumption at a sub-national level: An ecological footprint, nutritional and economic analysis. J. Environ. Policy Plan. 2007, 9, 5–30.
  200. Galli, A.; Iha, K.; Halle, M.; El Bilali, H.; Grunewald, N.; Eaton, D.; Capone, R.; Debs, P.; Bottalico, F. Mediterranean countries’ food consumption and sourcing patterns: An Ecological Footprint viewpoint. Sci. Total Environ. 2017, 578, 383–391.
  201. Costa Leite, J.; Caldeira, S.; Watzl, B.; Wollgast, J. Healthy low nitrogen footprint diets. Glob. Food Secur. 2020, 24, 100342.
  202. Oita, A.; Wirasenjaya, F.; Liu, J.; Webeck, E.; Matsubae, K. Trends in the food nitrogen and phosphorus footprints for Asia’s giants: China, India, and Japan. Resour. Conserv. Recycl. 2020, 157, 104752.
  203. Lassaletta, L.; Billen, G.; Garnier, J.; Bouwman, L.; Velazquez, E.; Mueller, N.D.; Gerber, J.S. Nitrogen use in the global food system: Past trends and future trajectories of agronomic performance, pollution, trade, and dietary demand. Environ. Res. Lett. 2016, 11, 095007.
  204. Chen, Z.; Xu, C.; Ji, L.; Feng, J.; Li, F.; Zhou, X.; Fang, F. Effects of multi-cropping system on temporal and spatial distribution of carbon and nitrogen footprint of major crops in China. Glob. Ecol. Conserv. 2020, 22, e00895.
  205. Blas, A.; Garrido, A.; Willaarts, B.A. Evaluating the water footprint of the Mediterranean and American diets. Water 2016, 8, 448.
  206. Blas, A.; Garrido, A.; Unver, O.; Willaarts, B. A comparison of the Mediterranean diet and current food consumption patterns in Spain from a nutritional and water perspective. Sci. Total Environ. 2019, 664, 1020–1029.
  207. Jalava, M.; Kummu, M.; Porkka, M.; Siebert, S.; Varis, O. Diet change—A solution to reduce water use? Environ. Res. Lett. 2014, 9, 074016.
  208. Jalava, M.; Guillaume, J.H.A.; Kummu, M.; Porkka, M.; Siebert, S.; Varis, O. Diet change and food loss reduction: What is their combined impact on global water use and scarcity? Earths Future 2016, 4, 62–78.
  209. Vanham, D.; Hoekstra, A.Y.; Wada, Y.; Bouraoui, F.; de Roo, A.; Mekonnen, M.M.; van de Bund, W.J.; Batelaan, O.; Pavelic, P.; Bastiaanssen, W.G.M.; et al. Physical water scarcity metrics for monitoring progress towards SDG target 6.4: An evaluation of indicator 6.4.2 “Level of water stress.”. Sci. Total Environ. 2018, 613–614, 218–232.
  210. Vanham, D.; Leip, A. Sustainable food system policies need to address environmental pressures and impacts: The example of water use and water stress. Sci. Total Environ. 2020, 730, 139151.
  211. Nogueira, J.P.; Hatjiathanassiadou, M.; de Souza, S.R.G.; Strasburg, V.J.; Rolim, P.M.; Seabra, L.M.J. Sustainable perspective in public educational institutions restaurants: From foodstuffs purchase to meal offer. Sustainability 2020, 12, 4340.
  212. Damerau, K.; Waha, K.; Herrero, M. The impact of nutrient-rich food choices on agricultural water-use efficiency. Nat. Sustain. 2019, 2, 233–241.
  213. Hess, T.; Andersson, U.; Mena, C.; Williams, A. The impact of healthier dietary scenarios on the global blue water scarcity footprint of food consumption in the UK. Food Policy 2015, 50, 1–10.
  214. Vanham, D.; Comero, S.; Gawlik, B.M.; Bidoglio, G. The water footprint of different diets within European sub-national geographical entities. Nat. Sustain. 2018, 1, 518–525.
  215. Donini, L.M.; Dernini, S.; Lairon, D.; Serra-Majem, L.; Amiot, M.-J.; del Balzo, V.; Giusti, A.-M.; Burlingame, B.; Belahsen, R.; Maiani, G.; et al. A consensus proposal for nutritional indicators to assess the sustainability of a healthy diet: The Mediterranean diet as a case study. Front. Nutr. 2016, 3.
  216. FAO; IFAD; UNICEF; WHO. The State of Food Security and Nutrition in the World (SOFI): Safeguarding Against Economic Slowdowns and Downturns; 2019; p. 239.
  217. Bahadur Kc, K.; Dias, G.M.; Veeramani, A.; Swanton, C.J.; Fraser, D.; Steinke, D.; Lee, E.; Wittman, H.; Farber, J.M.; Dunfield, K.; et al. When too much isn’t enough: Does current food production meet global nutritional needs? PLoS ONE 2018, 13, e0205683.
  218. Henchion, M.; Hayes, M.; Mullen, A.M.; Fenelon, M.; Tiwari, B. Future protein supply and demand: Strategies and factors influencing a sustainable equilibrium. Foods 2017, 6, 53.
  219. Lee, J.; Gereffi, G.; Beauvais, J. Global value chains and agrifood standards: Challenges and possibilities for smallholders in developing countries. Proc. Natl. Acad. Sci. USA 2012, 109, 12326–12331.
  220. Jarzębowski, S.; Bourlakis, M.; Bezat-Jarzębowska, A. Short food supply chains (SFSC) as local and sustainable systems. Sustainability 2020, 12, 4715.
  221. Kiff, L.; Wilkes, A.; Tennigkeit, T. The Technical Mitigation Potential of Demand-Side Measures in the Agri-Food Sector: A Preliminary Assessment of Available Measures; CCAFS Report No. 15; CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS): Copenhagen, Denmark, 2016; p. 52.
  222. De Ponti, T.; Rijk, B.; van Ittersum, M.K. The crop yield gap between organic and conventional agriculture. Agric. Syst. 2012, 108, 1–9.
  223. Macdiarmid, J.I. Seasonality and dietary requirements: Will eating seasonal food contribute to health and environmental sustainability? Proc. Nutr. Soc. 2014, 73, 368–375.
  224. Seufert, V. Comparing yields: Organic versus conventional agriculture. In Encyclopedia of Food Security and Sustainability; Ferranti, P., Berry, E.M., Anderson, J.R., Eds.; Elsevier: Oxford, UK, 2019; Volume 3, pp. 196–208. ISBN 978-0-12-812688-2.
  225. Wandel, J.; Smithers, J. Factors affecting the adoption of conservation tillage on clay soils in southwestern Ontario, Canada. Am. J. Altern. Agric. 2000, 15, 181–188.
  226. Banks, J.; Williams, J.; Cumberlidge, T.; Cimonetti, T.; Sharp, D.J.; Shield, J.P. Is healthy eating for obese children necessarily more costly for families? Br. J. Gen. Pract. 2012, 62, e1–e5.
  227. Fresán, U.; Martínez-González, M.A.; Sabaté, J.; Bes-Rastrollo, M. Global sustainability (health, environment and monetary costs) of three dietary patterns: Results from a Spanish cohort (the SUN project). BMJ Open 2019, 9.
  228. Saxe, H. The New Nordic Diet is an effective tool in environmental protection: It reduces the associated socioeconomic cost of diets. Am. J. Clin. Nutr. 2014, 99, 1117–1125.
  229. Saxe, H.; Jensen, J.D. Does the environmental gain of switching to the healthy new Nordic diet outweigh the increased consumer cost? ; San Francisco (USA), J. Food Sci. Eng. 2014, 24, 91–300.
  230. Johnston, J.L.; Fanzo, J.C.; Cogill, B. Understanding sustainable diets: A descriptive analysis of the determinants and processes that influence diets and their impact on health, food security, and environmental sustainability. Adv. Nutr. 2014, 5, 418–429.
  231. Nemeth, N.; Rudnak, I.; Ymeri, P.; Fogarassy, C. The role of cultural factors in sustainable food consumption— An investigation of the consumption habits among international students in Hungary. Sustainability 2019, 11, 3052.
  232. Suri, S.; Kumar, V.; Prasad, R.; Tanwar, B.; Goyal, A.; Kaur, S.; Gat, Y.; Kumar, A.; Kaur, J.; Singh, D. Considerations for development of lactose-free food. J. Nutr. Intermed. Metab. 2019, 15, 27–34.
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