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Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns
Background: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets. Objective: To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns. Methods: We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it. Conclusions: The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.
Journal Article
Field testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines among mothers/caregivers of children aged 12-36 months in the Stellenbosch Municipality in the Western Cape province, South Africa
Objective: To assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDGs) among mothers/caregivers of children aged 12-36 months. Exposure to guidelines with similar messages, barriers and enablers to following of the guidelines were also assessed.
Design: A descriptive cross-sectional qualitative study was conducted. Data were collected from nine focus-group discussions (FGDs) conducted in isiXhosa, English and Afrikaans, resulting in 65 participants, 20 from formal areas and 45 from informal areas.
Setting: Stellenbosch Municipality (Stellenbosch, Pniel and Franschhoek)
Subjects: The study population included mothers/caregivers older than 18 years, who consented to participate.
Results: This study revealed that participants expressed a general understanding of the core messages contained in the revised, draft SA-PFBDGs. Misinterpretation arose regarding certain guidelines as a result of ambiguity. Participants were familiar with and recognised the majority of the concepts conveyed owing to previous exposure, mostly from healthcare facilities and the media. Financial constraints were identified as the biggest barrier to following the guidelines, while perceived enablers included receiving education on the guidelines as well as visual portrayal thereof.
Conclusion: Following field-testing, it is clear that the draft, revised SA-PFBDGs for the age group 12-36 months are appropriate. Minor rewording is required to enhance understanding. Effective dissemination of the guidelines through multiple communication platforms is recommended.
Journal Article
Food-Based Dietary Guidelines – development of a conceptual framework for future Food-Based Dietary Guidelines in Europe: report of a Federation of European Nutrition Societies Task-Force Workshop in Copenhagen, 12–13 March 2018
Identifying a need for developing a conceptual framework for the future development of Food-Based Dietary Guidelines (FBDG) in Europe, The Federation of European Nutrition Sciences established a Task Force for this purpose. A workshop was held with the specific objective to discuss the various dimensions considered as particularly relevant. Existing frameworks for FBDG were discussed, and presentations from various countries illustrated not only several commonalities but also a high degree of heterogeneity in the guidelines from different countries. Environmental aspects were considered in several countries, and dimensions like food safety, dietary habits and preparation were included in others. The workshop provided an overview of the use of FBDG – both in developing front-of-pack nutrition labels and for reformulation and innovation. The European FBDG dimensions were described with examples from the close connection between FBDG and European Union (EU) policies and activities and from the compilation of a database of national FBDG. Also, the challenges with communication of FBDG were discussed. Considering the current scientific basis and the experiences from several countries, the Task Force discussed the various dimensions of developing FBDG and concluded that environmental aspects should be included in the future conceptual framework for FBDG. A change in terminology to sustainable FDBG (SFBDG) could reflect this. The Task Force concluded that further work needs to be done exploring current practice, existing methodologies and the future prospects for incorporating other relevant dimensions into a future Federation of European Nutrition Societies conceptual framework for SFBDG in Europe and working groups were formed to address that.
Journal Article
Scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta‐analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food‐Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category‐based nutrient profiling models, total fat could replace energy in most food groups owing to its high‐energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.
Journal Article
Food-Based Dietary Guidelines around the World: A Comparative Analysis to Update AESAN Scientific Committee Dietary Recommendations
Food-Based Dietary Guidelines (FBDG) include dietary recommendations based on food groups according to the general and accepted nutrition principles and current scientific evidence. Adoption of FBDG contributes to the prevention of malnutrition in all its forms, promotes human health, and reduces environmental impact. The present review aims to perform an international comparative analysis of the FBDG adopted in different countries from three different continents (America, Asia, and Europe), with particular reference to the Spanish Food Safety and Nutrition Agency (AESAN, Agencia Española de Seguridad Alimentaria y Nutrición) Scientific Committee dietary recommendations. A total of twelve countries with the most updated FBDG and/or closest to the traditional and cultural preferences of Spain were finally selected. All the reviewed FBDG provided recommendations for fruits, vegetables, cereals, legumes, nuts, milk and dairy products, meat and derivatives, fish, eggs, water, and oil; however, remarkable differences regarding recommended amounts were found among countries.
Journal Article
Fish availability mapping and food-based recommendations to promote an adequate vitamin D intake among pregnant women in East Lombok, Indonesia
Pregnant women are at higher risk of vitamin D deficiency due to increased nutritional requirements and limited dietary sources. Fish is the major source of vitamin D, but its availability varies by region. This study aims to assess the availability of vitamin D-rich fish and develop food-based recommendations (FBR) for pregnant women in East Lombok, Indonesia. This comparative cross-sectional study was conducted in East Lombok, Indonesia, which is part of Action Against Stunting cohort of pregnant women. Twenty-five village markets in the area were scored based on availability of vitamin D-rich fish and number of fish sellers in each market and were categorised into high availability (HD) for the highest quartile and low availability (LD) for the lowest quartile. Quantum Geographic Information System software was used to identify each of respondents’ houses using 2·4 km buffer zones to either HD or LD markets. Dietary intake data were collected from 24-h dietary recalls and linear programming analysis using Optifood was used to identify problem nutrient and dietary inadequacy. No significant difference in vitamin D intake was found between HD and LD areas ( P = 0·633). While both groups’ FBR ensure adequacy of Fe, Zn, vitamins A, B 1 , B 2 , B 3 , B 6 and B 12 , Ca remain as dietary inadequacy in the LD group, suggesting that availability play a role in ensuring dietary adequacy. Future studies to develop nutrient-dense foods and improved fish availability mapping which consider non-static position of market (mobile vendor) are recommended.
Journal Article
Breeding for micronutrients in staple food crops from a human nutrition perspective
Over three billion people are currently micronutrient (i.e. micronutrient elements and vitamins) malnourished, resulting in egregious societal costs including learning disabilities among children, increased morbidity and mortality rates, lower worker productivity, and high healthcare costs, all factors diminishing human potential, felicity, and national economic development. Nutritional deficiencies (e.g. iron, zinc, vitamin A) account for almost two‐thirds of the childhood death worldwide. Most of those afflicted are dependent on staple crops for their sustenance. Importantly, these crops can be enriched (i.e. ‘biofortified’) with micronutrients using plant breeding and/or transgenic strategies, because micronutrient enrichment traits exist within their genomes that can to used for substantially increasing micronutrient levels in these foods without negatively impacting crop productivity. Furthermore, ‘proof of concept’ studies have been published using transgenic approaches to biofortify staple crops (e.g. high β‐carotene ‘golden rice’ grain, high ferritin‐Fe rice grain, etc). In addition, micronutrient element enrichment of seeds can increase crop yields when sowed to micronutrient‐poor soils, assuring their adoption by farmers. Bioavailability issues must be addressed when employing plant breeding and/or transgenic approaches to reduce micronutrient malnutrition. Enhancing substances (e.g. ascorbic acid, S‐containing amino acids, etc) that promote micronutrient bioavailability or decreasing antinutrient substances (e.g. phytate, polyphenolics, etc) that inhibit micronutrient bioavailability, are both options that could be pursued, but the latter approach should be used with caution. The world’s agricultural community should adopt plant breeding and other genetic technologies to improve human health, and the world’s nutrition and health communities should support these efforts. Sustainable solutions to this enormous global problem of ‘hidden hunger’ will not come without employing agricultural approaches.
Journal Article
Planet-based diets: improving environmental sustainability of healthy diets
The focus of nutritionists is on improvement of the health impact of current diets. Therefore, it is important to ask the question whether healthy diets are more sustainable. This review provides an overview on the research on synergies between health and sustainability. Synergies are found from shifts from animal-based to plant-based diets, from ultra-processed foods to fresh and whole foods and from reduction of food waste. The importance of looking at sustainability of the present diets has led to steps made in Europe to incorporate sustainability into food-based dietary guidelines. Examples from UK, Nordics, Belgium and the Netherlands are given. World Wildlife Fund has summarised the insides in a future-proof diet: the planet-based diet within planetary boundaries.
Journal Article