A systematic review of food waste audit methods in hospital foodservices: development of a consensus pathway food waste audit tool (2022 Mar)

Cook N, Collins J, Goodwin D, Porter J. A systematic review of food waste audit methods in hospital foodservices: development of a consensus pathway food waste audit tool. J Hum Nutr Diet. 2022;35:68–80. https://doi.org/10.1111/jhn.12928

Open access link to article: 

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.12928 (can be read freely online)

Relevant to: 

Hospital foodservice (other institutional settings could also benefit)

Question: 

The present review aimed to collate reported methods and establish a preferred approach for conducting a waste audit in a hospital foodservice setting.  

Bottom line for nutrition practice: 

Measure aggregate food and food-related waste in hospital foodservices on a regular basis to generate baseline data, identify problem areas, and possibly demonstrate improvements in waste levels over time.

Abstract: 

Background: To understand, monitor and compare the scope of food waste in hospital foodservices, it is essential to measure food waste using a standardised method. The aims of this systematic review were to: (i) describe and critique the methodological features of waste audits used in hospital foodservice settings that measure aggregate food and food- related waste and (ii) develop a consensus tool for conducting a food waste audit in a hospital foodservice setting.

Methods: Seven electronic databases were searched for peer reviewed literature, and 17 Google Advanced searches located grey literature that described food waste audit methods previously used or developed for hospital foodservices. Study selection and quality assessment occurred in duplicate. Data describing the audit method, its feasibility, and strengths and limitations were extracted and synthesised to develop a consensus tool.

Results: Eight peer reviewed and nine grey literature documents describing a variety of food waste audit methods were found. The most common practices were 2- week data collection (n = 5), foodservice staff collecting data (n = 6), measuring food waste only (n = 11), measuring food waste at main meals (n = 5) and using electronic scales to measure waste (n = 12). A consensus tool was developed that proposes a method for preparing, conducting, and analysing data from a food waste audit.

Conclusions: This review used published evidence to develop the first ever food waste audit consensus tool for hospital foodservices to use and measure food and food-related waste. Future research is needed to apply and test this tool in practice.

Details of results: 

The development of a consensus tool to support hospital foodservice to make decisions on how to structure their food and food-related waste audit including:

  • how much data do they want to collect (1 day or 2 weeks),
  • what type of data do they want to collect (food waste, food-related waste, or both),
  • when do they want to collect data (before, during, or after service),
  • what equipment they will need (weighing scales, containers),
  • where they will collect data (patient kitchen, staff cafeteria, or both),
  • how to complete the audit (step by step methods) and
  • how will they analyse the data (per patient, total waste, cost).

Of additional interest: 

n/a

Editor’s comment:  

n/a 

Conflict of interest/ Funding:  

No conflicts reFunding provided by Department of Nutrition, Dietetics and Food, Monash University for PhD candidate Nathan Cook to complete the research.

External relevant links:  

Blog article about the research:  https://monashnutrition.blogspot.com/2021/09/whats-measured-is-managed-new-evidenced.html

Relevant Food Waste resources in this ICDA SFS Toolkit:

Corresponding author: 

Nathan Cook, nathan.cook@monash.edu

Plant-Based Meat and Dairy Substitutes as Appropriate Alternatives to Animal-Based Products? (2020)

Khandpur N, Martinez-Steele E, Sun Q. Plant-Based Meat and Dairy Substitutes as Appropriate Alternatives to Animal-Based Products? The Journal of Nutrition. 2020;151(1):3-4.  DOI: 10.1093/jn/nxaa351 (open archive)

Relevant to: 

All Dietitians-Nutritionists.

Question: 

This commentary poses practice and research questions about the nutrition and environmental consequences of the increased production and intake of ultra-processed plant-based meat and dairy substitutes. Their commentary reflects upon results from a study also reviewed on this website:  

Gehring J, Touvier M, Baudry J, Julia C, Buscail C, Srour B, et al. Consumption of Ultra-Processed Foods by Pesco-Vegetarians, Vegetarians, and Vegans: Associations with Duration and Age at Diet Initiation. The Journal of Nutrition. 2020;151(1):120-31. https://doi.org/10.1093/jn/nxaa196 (open archive)

Bottom line for nutrition practice: 

The Gehring et al. (2020) article illustrated a high intake of plant-based meat and dairy substitutes (PMDSs) by vegetarians. The study classified these foods as ultra-processed foods (UPFs), based on the NOVA classification of foods by level of processing (see: of additional interest). The authors of the commentary suggest that the substantial increase in the development and marketing of these products over the last few years has the potential to have a large impact on the nutritional quality of diets for vegetarians (and we would argue for any transitioning to a more plant-based diet).  

The authors of this commentary argue that we need a greater knowledge of PMDSs, including their degree of processing and the nutrient profile of the individual foods and the dietary patterns within which they are consumed. They also call for more research on the health and environmental impacts of PMDSs, as well as research instruments to examine these questions.  

Abstract:

N/A (Commentary)  

Details of results: 

Research trends in Europe suggest that the market for PMDSs will grow by almost 75% between 2018-2023. While the authors note that these products help in the transition toward a plant-based diet, they suggest that it is important to examine how this increase will affect nutritional intake. For example, while eating high quality plant-based foods rather than red meat has shown health benefits, this may not be true for replacing meat with low quality plant-based carbohydrates.   

On one hand, the authors cite an industry-funded trial showing several beneficial effects of the plant-based substitutes (when compared with equivalent animal products), including lowering LDL-cholesterol. However, the authors also cite a 2019 Food and Agriculture Organization (FAO) report linking the intake of both plant and animal origin UPFs with chronic diseases (see “Additional Information”). They suggest that evidence about nutritional quality and the health impacts may also influence how these products are scored by measurement tools such as Alternative Healthy Eating Index and the Dietary Approaches to Stop Hypertension.  

The authors also note that the environmental impacts of this shift need to be examined, including the production systems for PMDSs, which may differ from current systems and thus have the potential for different impacts.  

Of additional interest: 

The four NOVA levels of food by level of processing include: 1. Unprocessed and minimally processed foods; 2. Processed culinary ingredients; 3. Processed foods; and 4. Ultra-processed foods. 

For more information on the NOVA classification see: Monteiro, C.A., Cannon, G., Lawrence, M., Costa Louzada, M.L. and Pereira Machado, P.2019. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome, FAO. http://www.fao.org/3/ca5644en/ca5644en.pdf 

Food and Agriculture Organization. Ultra-processed foods, diet quality and human health. Rome, Italy: FAO; 2019. Available from: http://www.fao.org/publications/card/en/c/C A5644EN/  

Editor’s comment:  

There is such a wide variation in PMDS products. For example, some plant based “meat” patties have many additives, whereas some have a minimal amount of ingredients. It seems that there should be a way to differentiate between these foods. 
A discussion about this term can be found at:  
https://www.tabledebates.org/building-blocks/what-ultra-processed-food-and-why-do-people-disagree-about-its-utility-concept 

The shift toward more PMDSs also has the potential to shift overall intake toward specific foods. For example, rice can be a significant ingredient in some of these foods. As some rice has naturally occurring arsenic, does this pose a problem?   

We would also note that social sustainability of these shifts also needs to be considered. For example, the increased intake of quinoa by the West is purported to have decreased the availability of the food for local consumption where originally grown.  

See also on this site a synopsis of: Smetana S, Mathys A, Knoch A, Heinz V. Meat alternatives: life cycle assessment of most known meat substitutes. The International Journal of Life Cycle Assessment. 2015 2015/09/01;20(9):1254-67. (pay wall)

Conflict of interest/ Funding:  

No conflicts declared 

External relevant links:  

n/a

Corresponding author: 

neha.khandpur@usp.br 

updated 2024 October

Comparative analysis of environmental impacts of agricultural production systems, agricultural input efficiency, and food choice (2017)

Clark M, Tilman D. Comparative analysis of environmental impacts of agricultural production systems, agricultural input efficiency, and food choice. Environmental Research Letters. 2017 2017/06/01;12(6):064016. https://iopscience.iop.org/article/10.1088/1748-9326/aa6cd5/meta (open access)

Relevant to: 

All Dietitians-Nutritionists  

Question: 

The authors performed a meta-analysis of life cycle assessments across 164 publications (pre July 2015) to compare the environmental impacts* of different: agricultural production systems, agricultural input efficiencies, and foods. This includes (but is not limited to), an analysis of grass-fed and grain-fed beef; trawling and non-trawling fisheries; and greenhouse grown and field produce. Eighty-six % of the publications were from highly industrialized systems in Europe, North America, and Australia and New Zealand.  

*greenhouse gas emissions, land use, fossil fuel energy use, eutrophication and acidification potential 

Bottom line for nutrition practice: 

The results illustrate that environmental impacts of agricultural production systems are different depending on which systems, food, and environmental indicators are examined. The difference in environmental impacts between foods of different types is large compared to the difference between the same foods produced using different systems. For all environmental indicators and nutritional units assessed, plant-based foods have the lowest environmental impacts – even when analyzed per kilocalorie of food produced.  

Organic systems use more land, result in more eutrophication and require less energy per unit of  food as compared to conventional systems. Grain fed beef uses less land than grass fed beef, and trolling fisheries have much higher GHG emissions than low-input aquaculture and non-trawling fisheries. Additionally, increasing agricultural input efficiency (the amount of food produced per input of fertilizer or feed) is associated with lower environmental impacts for both crop and livestock systems. 

The authors suggest, however, that these results should not be understood to mean that conventional systems are more sustainable than organic systems, as conventional systems require more energy and rely on high nutrient, herbicide, and pesticide inputs which can negatively impact human and environmental health. Rather, they suggest that systems should integrate the benefits of both systems to develop more sustainable agriculture (e.g., organic’s lower use of chemical inputs, and higher yields in conventional systems). Finally, results are relevant only to highly industrialized systems.  

Abstract:

Global agricultural feeds over 7 billion people but is also a leading cause of environmental degradation. Understanding how alternative agricultural production systems, agricultural input efficiency, and food choice drive environmental degradation is necessary for reducing agriculture’s environmental impacts. A meta-analysis of life cycle assessments that includes 742 agricultural systems and over 90 unique foods produced primarily in high-input systems shows that, per unit of food, organic systems require more land, cause more eutrophication, use less energy, but emit similar greenhouse gas emissions (GHGs) as conventional systems; that grass-fed beef requires more land and emits similar GHG emissions as grain-feed beef; and that low-input aquaculture and non-trawling fisheries have much lower GHG emissions than trawling fisheries. In addition, our analyses show that increasing agricultural input efficiency (the amount of food produced per input of fertilizer or feed) would have environmental benefits for both crop and livestock systems. Further, for all environmental indicators and nutritional units examined, plant-based foods have the lowest environmental impacts; eggs, dairy, pork, poultry, non-trawling fisheries, and non-recirculating aquaculture have intermediate impacts; and ruminant meat has impacts ~100 times those of plant-based foods. Our analyses show that dietary shifts towards low-impact foods and increases in agricultural input use efficiency would offer larger environmental benefits than would switches from conventional agricultural systems to alternatives such as organic agriculture or grass-fed beef. 

Details of results: 

Five environmental indicators were examined, including greenhouse gas emissions, land use, energy use, eutrophication potential (a measure of nutrient runoff), and acidification potential (a measure of nutrient loading – for further explanation see “of additional interest”). Other indicators that were not included in the  data sets, such as impacts on biodiversity and pesticide use, were not measured. The life cycle assessments used to assess the food’s environmental impact were calculated by weight of food, and also by kilocalorie, gram protein, and USDA serving (serving size recommended by the US Department of Agriculture). Results are outlined above under “bottom line” and within the abstract. Instead, this section will focus on the author’s explanations of the findings.  

The authors suggest that the higher land use eutrophication potential in organic systems could occur due to nutrient mismatch. This is explained in detail within the article (p.4), but an example they illustrate is manure application, which releases nutrients that are not matched with crop nutrient demand and thus increases the amount of nutrients not absorbed by plants. The authors also indicate, however, that comparisons between organic and conventional were limited to within the same publication, so results are representative at the local scale and not necessarily at the regional, national, or global scale.  Regarding land use, they note that other researchers have found that techniques such as “rotational farming, cover cropping, multi-cropping, and polyculture in organic systems can halve the land use difference between organic and conventional systems” (p.4). The authors also state that organic production systems may be beneficial to human and environmental health in other ways not examined in this study such as: higher micronutrient concentrations; lower pesticide residues; farm biodiversity; and soil organic carbon. However, if organic agriculture requires clearing of land, then the impact on biodiversity and soil organic carbon would still be greater than for conventional systems.  

The authors suggest that one of the reasons that grass fed beef has higher land use and tendency toward higher greenhouse gas emissions occurs due to lower macronutrient densities and digestibility of feeds than grain-fed systems. This in turn means that grass fed beef requires greater feed inputs. Further explanation on the environmental impacts of grass-fed beef is detailed within the article (p.5). For example, a longer life for grass fed cattle results in greater greenhouse gas emissions per unit of food. Conversely, they also suggest ways that grass fed beef might have human and environmental health benefits which they were unable to examine (i.e., soil carbon sequestration, promotion of food security on land not suitable for crop production, within-pasture nutrient cycling which could decrease eutrophication, and increased micronutrient concentration and improved fatty acid profile for human health). And while they suggest that aquaculture-raised fish from non-recirculating systems (e.g., aquaculture in ponds, fjords, rivers, etc.) could decrease pressure on over harvested fisheries and lower greenhouse gas emissions – particularly in relation to trawling fisheries – there are large discrepancies between the impacts of different aquaculture systems (for more details, see p. 6).  

To assess agricultural input efficiency, the authors examined the amount of food produced per unit of fertilizer or feed input in non-rice cereal and non-ruminant livestock systems. As noted above, they found that systems with higher agricultural input efficiency are associated with lower environmental impacts. The authors outline technologies and management techniques (p.8) which could increase agricultural input efficiency.  

In investigating the environmental impact of various foods, the authors illustrate that “foods with low impact for one environmental indicator tend to have low impacts for all environmental indicators examined”(p.8). Across all indicators, ruminant meat had 20-100 times greater impact than plant-based foods per kilocalorie of food produced, while milk, eggs, pork, poultry, and seafood had 2–25 times greater impact. This trend also held true when foods were assessed per gram protein, USDA serving, or by weight.  

Of additional interest: 

“Acidification potential… includes acidification potential from sulfur dioxide, nitrogen oxides, nitrous oxide, and ammonia, among others. Acidification potential is a measurement of the potential increase in acidity of an ecosystem, [and occurs from activities such as]… fertilizer application, fuel combustion, and manure management… Excess acidification makes it more difficult for plants to assimilate nutrients, and thus results in decreased plant growth. In addition, nutrient applications not incorporated into plant growth cause eutrophication and acidification, thereby driving the higher eutrophication potential and tendency for higher acidification potential in organic systems” (p.3), (although the latter was not a significant difference).  

Editor’s comment:  

It is useful to see an article which outlines the nuances of different food production systems, rather than taking a black-and-white look at organic vs. Conventional agriculture This is important as dietitian-nutritionists are often asked about whether organically produced foods are more sustainable. Further, it is helpful to see findings showing that animal foods have a higher environmental impact when measured by kilocalories or grams of protein, as animal producers have used the argument that measuring by weight was not an accurate portrayal of the nutritional importance of differing foods.  

Conflict of interest/ Funding:  

Support for this research came from the Balzan Foundation, the McKnight Presidential Chair, and the University of California, Santa Barbara. The authors notes that some publications conducted by for-profit companies were excluded due to potential biases. 

External relevant links:  

N/A 

Corresponding author: 

maclark@umn.edu 

updated 2024 October

Sustainable diet policy development: implications of multi-criteria and other approaches, 2008–2017

Lang T, Mason P. Sustainable diet policy development: implications of multi-criteria and other approaches, 2008-2017. Proc Nutr Soc. 2018 Aug;77(3):331-46. 

Relevant to: 

Dietitians-nutritionists working in policy development.  

Question: 

This paper identifies various policy approaches used by primarily by countries, but also other sectors that have integrated sustainability into dietary guidelines. It then articulates lessons learned from these approaches.  

Bottom line for nutrition practice: 

The authors argue that support for sustainable diets is increasing. This is strengthened by global policy agendas such as the 2015 United Nations Sustainable Development Goals (SDG) and the Paris Climate Change Accord, which require action in diet and food systems. The authors suggest that considerable international experience now exists on evidence-based sustainable dietary guidelines, allowing for an analysis of policy approaches.  

Lessons learned are outlined in more detail below, but include the following:  Dietary policy is highly political, and policy advancement is unlikely to be achieved by science and evidence alone. Approaching sustainable diets as multi-criteria (e.g., rather than simply nutrition and environment only) and using a multi-sectoral approach engages a wider scope of sectors who may be more likely to shift current policies toward advancing sustainable diets. The state is an important leader, as they can mediate different interests.  

The authors suggest that nutrition scientists have an important opportunity specifically in relation to sustainability within dietary guidelines; they also encourage nutrition professionals to promote the relationship between diet and sustainability, why this should be of concern to the public, and suggest that they should participate in the development of goals for the food supply that link health, the environment and the economy.  

Abstract:

The objective of the present paper is to draw lessons from policy development on sustainable diets. It considers the emergence of sustainable diets as a policy issue and reviews the environmental challenge to nutrition science as to what a ‘good’ diet is for contemporary policy. It explores the variations in how sustainable diets have been approached by policy-makers. The paper considers how international United Nations and European Union (EU) policy engagement now centres on the 2015 Sustainable Development Goals and Paris Climate Change Accord, which require changes across food systems. The paper outlines national sustainable diet policy in various countries: Australia, Brazil, France, the Netherlands, Qatar, Sweden, UK and USA. While no overarching common framework for sustainable diets has appeared, a policy typology of lessons for sustainable diets is proposed, differentiating (a) orientation and focus, (b) engagement styles and (c) modes of leadership. The paper considers the particularly tortuous rise and fall of UK governmental interest in sustainable diet advice. Initial engagement in the 2000s turned to disengagement in the 2010s, yet some advice has emerged. The 2016 referendum to leave the EU has created a new period of policy uncertainty for the UK food system. This might marginalise attempts to generate sustainable diet advice, but could also be an opportunity for sustainable diets to be a goal for a sustainable UK food system. The role of nutritionists and other food science professions will be significant in this period of policy flux. 

Details of results:

The authors differentiate between three types of policy approaches that have been taken in the development of sustainable dietary guidelines. The first is orientation – whether the approach is simple (nutrition, plus one more factor), complex (multi-criteria), incremental (slow accrual of policy advice), or core (whether non-nutrition issues are approached in an overt or covert way). Second, engagement styles can be soft (e.g., labelling, which puts responsibility on the consumer), hard (e.g., policy regulation) or choice-editing (where action occurs mostly at the pre-consumer level). Third, modes of leadership include state, business and civil society.  

The authors outline lessons from the different policy approaches to sustainable dietary guidelines. 

First, the authors suggest that current discourse is divided over whether policy integration is best addressed through a simple approach or a complex, multi-criteria approach. However, given their observation that political engagement is unlikely to be gained by evidence alone, they suggest that approaching sustainable diets as complex can be advantageous; it is a way to engage a wider scope of sectors who may be more likely to shift current policies toward advancing sustainable diets. Policy tensions at national levels will continue as to whether dietary guidelines should move beyond the purview of health and nutrition to include other areas such as the environment, culture and economics.  

Promoters of sustainable diets should consider focusing guidelines on nutrition, but also using dietary change as a way to advance other criteria (e.g., the Qatar dietary guidelines used breastfeeding to promote sustainability). As noted above, the state can be an effective leader, as they can mediate varied interests. The effectiveness of top-down state approaches, however, remains to be seen.  

Finally, the authors suggest that while sustainable diets have been a politically sensitive policy matter, clear sustainable dietary guidelines are now needed to fulfill the UN SDG and require long-term support and political commitment.  

Of additional interest: 

For those interested in the UK, the paper ends with a reflection of the UK’s experience related sustainable diets (written prior to Brexit).  

See also the book by the same authors: Sustainable Diets: How Ecological Nutrition Can Transform Consumption and the Food System P. Mason and T. Lang. Routledge 2017 https://books.google.ca/books?id=pDxIvgAACAAJ 

Editor’s comment:  

N/A 

Open access link to article: 


https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/sustainable-diet-policy-development-implications-of-multicriteria-and-other-approaches-20082017/EDEF328498D1F502A6BF4F6298BF9329 

Conflict of interest/ Funding: 

N/A  

N/A 

Corresponding author: 

t.lang@city.ac.uk 

Association between sustainable dietary patterns and body weight, overweight, and obesity risk in the NutriNet-Santé prospective cohort

Seconda L, Egnell M, Julia C, Touvier M, Hercberg S, Pointereau P, et al. Association between sustainable dietary patterns and body weight, overweight, and obesity risk in the NutriNet-Santé prospective cohort. The American Journal of Clinical Nutrition. 2019;112(1):138-49

Relevant to:

Dietitians-nutritionists working in community, clinical or food service settings.

Question:

This study investigated the associations between sustainable dietary patterns and overweight and obesity in French adults. It first calculated a Sustainable Diet Index (SDI) from information collected from 15,626 participants of the NutriNet-Santé study. It then compared weight gain over time and the risk of overweight and obesity using longitudinal data collected between 2014-2018 to this baseline information. 

Bottom line for nutrition practice:

The results suggest that people who adopt highly sustainable dietary patterns sustainable diets may have a lower risk of weight gain, overweight, and obesity than those who do not adopt these behaviours. The results held true after multiple adjustments were made for demographic and lifestyle characteristics.

Abstract:

Background
Improving the sustainability of current food systems may prevent future public health, environmental, and social concerns.
Objective
Our objective was to investigate the associations between sustainable dietary patterns, assessed using the Sustainable Diet Index (SDI), and the risk of obesity, overweight, and weight gain in French adults, with a prospective design.
Methods
In 2014, the SDI was computed among 15,626 participants of the NutriNet-Santé study (of whom 76% were women) using data collected within the BioNutriNet project. The SDI ranges from 4 (lowest sustainability) to 20 points and includes 4 subindexes representing the 4 pillars of a sustainable diet. Longitudinal data of weight and height were collected yearly from 2014 to 2018. We used mixed models to estimate the associations between sex-specific quintiles (Qs) of the SDI and weight change and Cox proportional hazard models with different levels of adjustments to assess the association between sex-specific Qs of the SDI and risk of obesity and overweight (mean follow-up time: 2.8 y).
Results
At baseline, a higher percentage of participants with overweight was observed in the first SDI Q, reflecting the lowest sustainable dietary patterns (Q1), than in Q5 (29.83% compared with 12.71%). Compared with Q5, a slight increase (at the population level) of almost 160 g/y was observed in Q1, whereas weight remained relatively stable among participants in other Qs. In total, 281 incident cases of obesity and 777 cases of overweight were identified during the follow-up. Participants in Q1 had a higher risk of obesity and overweight than participants in Q5 (HR comparing Q1 with Q5: 4.03; 95% CI: 2.42, 6.10; P-trend < 0.001; and HR comparing Q1 with Q5: 1.49; 95% CI: 1.13, 1.95; P-trend < 0.001, respectively).
Conclusions
The findings support a potential protective role for more sustainable diets to prevent the risk of weight gain, overweight, and obesity. This trial was registered at clinicaltrials.gov as NCT03335644.

Details of results:

A Sustainable Diet Index (SDI) was developed for the study and used 7 indicators categorized into 4 sub-indexes: i) environmental (land occupation, greenhouse gas emissions, primary energy consumption);
ii) nutritional difference between energy need and intake in absolute terms, probability of adequate nutrient intake, contribution of organic food to diet), ii) economic (proportion of income devoted to diet), and iv) sociocultural (food practices such as place of food purchase, and ready-made products – the latter acting as a proxy of cooking practices). Sociodemographic and lifestyle data were also collected.

Participant results were divided into 5 equal categories (quintiles). Overall, participants having the lowest SDI had a higher risk of obesity and overweight than participants having the highest SDI. At the baseline (beginning of the study), participants with the lowest SDI score had 29.83% overweight compared with 12.71% of participants in the quintile with the highest SDI. At the end of the study, the quintile with the lowest SDI had a small but statistically significant weight gain (160g per year) compared to the quintile with the highest SDI. Weight stayed relatively stable among the participants in the other quintiles. As expected, sociodemographic and lifestyle characteristics differed across the categories (e.g., higher education, income and activity were associated with the quintile having the highest SDI). However, the researchers reported that even after multiple adjustments were made for demographic and lifestyle characteristics, the associations still remained significant. Therefore, the researchers suggest that the results support a potential protective role for sustainable diets in preventing the risk of weight gain, overweight, and obesity.

The authors list possible reasons for these associations, including: a higher energy intake in the lowest SDI quintile and a higher consumption of fruit and vegetables in the high SDI quintile. They also refer to the larger body of literature showing that that higher quality of diets are associated with lower potential weight gain and obesity; higher energy density of meat products or increased concentrations of some nutrients such as saturated fatty acids or cholesterol may be involved in weight outcomes; and, food production methods or processes such as cooking practices or consumption of organic foods may be a factor in weight maintenance (regarding the latter, literature discusses the exposure to synthetic pesticides and in particular endocrine disruptors may be a risk for obesity).

Of additional interest:

N/A

Editor’s comment:


While these results might be expected in any dietary pattern which focuses on improving dietary quality, the researchers note that – to their knowledge – this is the first study to quantitatively estimate these associations using a validated, multidisciplinary index.

Open access link to article:


https://academic.oup.com/ajcn/article/112/1/138/5613092

Conflict of interest/ Funding:

N/A

External relevant links:

N/A

Corresponding author:

l.seconda@eren.smbh.univ-paris13.fr

Climate change and Indigenous Health Promotion (2019)

Citation: Jones R. Climate change and Indigenous Health Promotion. Global Health Promotion. 2019;26(3_suppl):73-81. doi:10.1177/1757975919829713 (open access)

Relevant to: 

Public health Dietitians-Nutritionists working in any type of health promotion. While based on the perspectives of the Māori (the Indigenous people of Aotearoa/New Zealand), the ideas are relevant to all working in climate action. 

Question: 

This commentary type article uses a Māori perspective to examine the relationships between climate change and Indigenous health, and proposes implications for health promotion.  

Bottom line for nutrition practice: 

Indigenous people of the world are disproportionally impacted as a result of climate change. Climate action – through mitigation and adaptation – may also harm Indigenous peoples and erode their rights. Western views of climate change have framed the issue and therefore are also used to generate solutions. Indigenous knowledges and values, that see humans as not separate from the natural world and not superior to other life forms, have been excluded. 

The author poses that the views, values and systems that are the foundation of colonialization of Indigenous peoples are also at the root of environmental changes that threaten ecosystems. He suggests that health promotion be grounded in an understanding of how colonialization may worsen climate related impacts on Indigenous health. They further pose that land must be recognized as a key determinant of Indigenous health due to the many connections between land and human well-being. 

Abstract:

Climate change poses a serious threat to the health and well-being of Indigenous peoples around the world. Despite living in diverse contexts, Indigenous peoples face a number of common challenges. Disproportionate threats from climate change exist due to a range of factors including unique relationships with the natural environment, socioeconomic deprivation, a greater existing burden of disease, poorer access to and quality of health care, and political marginalization. Responses to climate change at global, national, and local levels also threaten Indigenous people’s rights.

While climate action presents many opportunities to improve health and reduce inequities, there is also significant potential for climate mitigation and adaptation policies to inflict harm on Indigenous peoples. An important aspect of this is the impact on traditional lands, which are acknowledged as a fundamental determinant of Indigenous health and well-being. This article seeks to elucidate the relationships between climate change and Indigenous health and to inform health promotion solutions to achieve climate justice for Indigenous peoples.

The underpinning analysis is founded on a Kaupapa Māori positioning, which seeks transformative change and involves critiquing Western knowledges and structures that undermine Indigenous rights. A central theme is that anthropogenic climate change is intimately connected to the ideologies, systems and practices of colonialism, and that the impacts on Indigenous peoples can be conceptualized as an intensification of the process of colonization. It is not possible to understand and address climate-related health impacts for Indigenous peoples without examining this broader context of colonial oppression, marginalization and dispossession.

The challenge for health promotion is to engage in a process of decolonization. This involves deconstructing its own systems and practices to avoid reinforcing colonialism and perpetuating inequities. It also requires health promotion practitioners to support Indigenous self-determination and recognize Indigenous knowledges as a critical foundation for climate change and health solutions.  

More details: 

Indigenous people of the world are disproportionally impacted as a result of climate change, with many exposed to conditions that leave them more vulnerable to climate change such as socioeconomic deprivation, poorer access to and quality of health care, greater level of disease, and political marginalization. Further, many also have a unique relationship with the natural environment (e.g., co-existing with the land for food and medicine); land is central to Indigenous peoples (see link to UN Declaration under “Of additional interest”). 

Climate mitigation and adaptation efforts may also negatively impact Indigenous peoples. For example, carbon pricing mechanisms may disproportionately impact those living with low income, reforestation projects can disrupt traditional practices such as hunting, and renewable energy projects have negatively impacted culturally significant sites. 
 
Western framing and solutions for climate change have not included Indigenous perspectives. A shift in health promotion toward ecological public health, focusing on the interconnectedness between humans and the natural environment aligns with Indigenous worldviews, but they are not the same.  

The author suggests that the ideologies, systems and practices that are the foundation of colonialization of Indigenous peoples (such as the anthropocentric values of consumption associated with improved quality of life, the commodification and exploitation of natural resources, capitalism and individualism) are also at the root of environmental changes that threaten ecosystems. He suggests that in order to understand and address the impacts of climate change for Indigenous health, that Health Promotion needs to engage in a process of decolonization, and critically examine the ways in which its own systems and practice reinforce colonialism, inequities and power imbalances. He further poses that health promotion practitioners need to support Indigenous self-determination, and recognize that space needs to be created for Indigenous knowledges in generating solutions for climate change and health.   

Of additional interest: 

The United Nations Declaration on the Rights of Indigenous Peoples acknowledges that ‘Indigenous peoples have the right to the lands, territories and resources which they have traditionally owned, occupied or otherwise used or acquired’. See: https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf 

Editor’s comment:  

The author seems to allude to, but not directly state, the idea that Indigenous perspectives on climate change may be beneficial to all of humanity. 

Conflict of interest/ Funding: 

None declared.  

Plant-based meat substitutes in the flexitarian age: an audit of products on supermarket shelves (2019 Oct)

Citation: Curtain F, Grafenauer S. Plant-Based Meat Substitutes in the Flexitarian Age: An Audit of Products on Supermarket Shelves. Nutrients. 2019 Oct 30;11(11):2603. doi: 10.3390/nu11112603. PMID: 31671655; PMCID: PMC6893642. https://doi.org/10.3390/nu11112603 (open access)

Relevant to: 

Public health Dietitians-Nutritionists working on government policy and Dietitians-Nutritionists in education and nutrition care.   

Question:

This Australian study compared plant-based meat substitutes that mimicked meat with equivalent meat products; it examined ingredients, nutrition information panel, health and nutrition claims, Health Star Rating (Australian), and any additional logos and endorsements. The study did not include traditional vegetarian meat alternatives such as such as tofu, tempeh, and falafel.

Bottom line for nutrition practice: 

There is a wide range of ingredients in these products, and they are not necessarily similar to, or healthier than meat.  
Guidance needs to be provided to consumers about creating healthy plant-based diets. This lack of nutritional equivalence with similar meat products could be especially problematic for those who may already not have enough of some key nutrients.  

Abstract:

Demand for plant-based meat substitutes is growing globally for nutritional and environmental reasons, with Australia the third-fastest growing vegan market worldwide. This study aimed to profile and compare plant-based meat substitutes (mimicking meat) with equivalent meat products, and 2015 data. An audit undertaken in May (updated in September 2019) from four metropolitan Sydney supermarkets (Coles, Woolworths, Aldi, IGA), collected nutrition information and Health Star Rating (HSR) from 137 products (50 burgers, 10 mince, 29 sausages, 24 chicken, 9 seafood, 15 other). Mean (± standard deviation (SD)) and median (range) was calculated for nutrients and HSR. Plant-based options were generally lower in kilojoules, total and saturated fat, higher in carbohydrate, sugars, and dietary fibre compared with meat. Only 4% of products were low in sodium (58–1200 mg/100 g). Less than a quarter of products (24%) were fortified with vitamin B12, 20% with iron, and 18% with zinc. HSR featured on 46% (3.6–4.4 stars). On-pack claims were vegetarian/vegan/plant-based (80%), protein (63%), non-genetically modified/organic (34%), gluten free (28%). Product numbers increased five-fold (↑429%) in four years. The plant protein trend has prompted innovation in meat substitutes, however wide nutrient ranges and higher sodium levels highlights the importance of nutrition guidelines in their development to ensure equivalence with animal-based proteins.

Details of results: 

In general, compared to meat, these plant-based meat substitutes were lower in energy and total and saturated fat, and were higher in carbohydrate, sugars and dietary fibre. Less than 24% were fortified with vitamin B12, iron and zinc (which are naturally present in meat). Micronutrients such as selenium, phosphorus, niacin or amino acid profile were not studied, but may also be important to consider. 
 
Some of the plant-based products were higher sodium than meat, but others were not. Similarly, some met Australian sodium reformulation targets, but some did not. The authors suggest that high sodium levels have also been demonstrated in other studies of these products, and is of particular importance as sodium is a lead dietary factor in the global burden of disease.  

Two-thirds of products studied contained legumes (these products had between 9%–65% legume ingredients). Twenty percent of burgers contained >8 g whole grain per serving size. The authors suggest that some of these products may be used to increase the intake of legumes and whole grains in a convenient type of food that has known acceptability. They also pose that nutrition claims and labelling could be more consistently and effectively used for this category. 

Consumers may assume that the products: a) have a nutrition profile similar to meat, and b) are healthier (“health halo” effect). There are, however, no universal regulations related to characterizing plant-based meat substitutes that mimic the taste, texture, and appearance of animal-based products. The authors suggest that governments set product reformulation regulations for plant-based meat and dairy substitutes. Reformulation policy occurs where the government sets standards for food reformulation to improve nutrient composition while still appealing to consumer interests such as taste, convenience and affordability. Fortification with vitamins and sodium restriction are examples that have occurred in many countries. 

Of additional interest: 

The authors alluded to studies which suggested that these products are not necessarily used by vegans/ vegetarians, but more so by those interested in decreasing meat (e.g., flexitarian). They further pose that these products may be more socially and culturally acceptable (depending on region) as easily stand in for traditional meat (e.g., plant-based burger versus regular at fast food restaurant, or at a family/ friends’ barbeque). They also cite a recent study which found that taste, appearance and availability were far more important than environmental arguments for those purchasing from this category.  

Editor’s comment:

Each product needs to be considered independently, and in the context of the broader diet or menu pattern.  

Conflict of interest/ Funding:

Grains & Legumes Nutrition Council (a not-for-profit charity) funded the research.  

External relevant links: 

See WHO summary sheet on food product reformulation.

updated 2024 October

Integrating sustainable nutrition into health-related institutions: a systematic review of the literature (2020)

Citation: Guillaumie, L., Boiral, O., Baghdadli, A. et al. Integrating sustainable nutrition into health-related institutions: a systematic review of the literature. Can J Public Health 111, 845–861 (2020). https://doi-org.ezproxy.acadiau.ca:9443/10.17269/s41997-020-00394-3 

Relevant to: 

Dietitians-Nutritionists working in health-related institutions.  

Question: 

This systematic review of 20 studies identified factors that influence health professionals’ practice of integrating sustainable nutrition into their work. Most studies (70%) focused on dietitians and were conducted in “Western” countries; systematic reviews or position papers were not included. The terms “sustainable nutrition” and “sustainable diets” are used interchangeably in the study. 

Bottom line for nutrition practice: 

Twenty-five factors influencing the integration of sustainable nutrition into professional practice were reported. Factors most reported include (n= # studies where identified): perceived knowledge of sustainable nutrition (n = 16); perceiving environmental issues to be part of one’s professional role (n = 13); awareness of environmental issues (n = 11); and perceived skills and self-efficacy (9). Respondents also recommended:  the need to promote sustainable diets among the general population (e.g., public health campaigns) (n = 11); the need to provide operational guidelines on sustainable nutrition and lobby for improved labelling laws (n = 10); and the importance of informing patients and educating the general population (n = 10). Overall, respondents emphasized that their place of practice prioritized health promotion, and while they saw them as important, environmental issues were a lower priority. 

The authors discussed a need to “institutionalize professional practices surrounding sustainable nutrition”,  

noting that study participants expressed the need for public organizations and decision-makers to prioritize and legitimize sustainable nutrition and develop policies and guidelines related to it.  

In addition to health-related institutions, they suggest that influencing factors also need to be addressed at the societal level (e.g., awareness campaigns), the political level (e.g., government policies), the industrial level (e.g., marketing), the organizational level (e.g., policies and procedures), and the educational level (e.g., universities). 

Abstract:

Objectives: Sustainable nutrition is increasingly important, as the food system contributes one third of greenhouse gas emissions. Sustainable nutrition, or sustainable diet, refers to diets with low environmental impacts that contribute to food security and health. This systematic review aimed to identify factors that influence whether professionals in health-related institutions integrate sustainable nutrition into their practice. 
Methods: A mixed-methods systematic review was conducted using the MEDLINE, Embase, PsycINFO, and CINAHL databases. To be included, the studies had to document perspectives on sustainable nutrition from health professionals, including dietitians, students and educators in health sciences, public health officers, and hospital food service managers. Data extraction focused on perceived barriers, facilitating factors, and top recommendations for promoting sustainable nutrition. 
Synthesis: Twenty studies were included, most of which focused on dietitians. Data analysis revealed that 25 factors influenced the integration of sustainable nutrition into professional practice. The factors most reported in the included studies were perceived knowledge of sustainable nutrition, self-efficacy, awareness of environmental issues, and perceiving the promotion of sustainable nutrition to be part of one’s professional role. Increasing societal support through awareness campaigns and increasing institutional support through guidelines, information tools, and financial support were also frequently mentioned. 
Conclusion: Sustainable nutrition is a multifaceted concept; integrating it into already complex professional practices is therefore challenging. At the present time, dietitians seem to be the health professionals predominantly researched regarding their views on sustainable nutrition. Many concrete avenues to promote sustainable nutrition were identified through this review. 

Details of results: 

Data from each study were categorized into four main categories of factors influencing the integration of sustainable nutrition: social and demographic characteristics of professionals; knowledge, attitudes, and values of professionals; skills and professional practices; and health system characteristics and practice settings. (n= # studies where factor was cited).  

1. Social and demographic characteristics of professionals: 
Current or past vegetarianism or veganism influenced knowledge and integration of sustainable nutrition principles (n = 5). Dietitians who had been practicing longer reported a lesser intent to include sustainable nutrition into their practice (n = 5), however, this may be less valid for urban Dietitians and those with higher levels of education.  

2. Knowledge, attitudes, and values of professionals:  
Professionals’ knowledge was the most frequently cited factor (n = 16), and it was described as a prerequisite for integrating sustainable nutrition. The need for more knowledge was reported, and very few reported that sustainable nutrition had been part of their dietetic curriculum.  

Most respondents saw environmental issues as part of their professional role (n = 13), and saw that educating clients on sustainable nutrition as important (n = 10), however, reported that priority is given to health and food security issues. Professionals’ awareness of environmental issues (n = 11) was also frequently reported, and they noted that professional and personal beliefs could not be separated.  

3. Skills and professional practices  
While factors in this category were noted less frequently than others, several are of note. First, “having access to evidence-based facts and information” (n = 8); Dietitians reported the need for client tools and a uniform message regarding sustainable nutrition. Whether priority is given to environmental issues at their place of practice was noted as a factor (n = 8); where low priority was reported, this was noted as a barrier. Related to this, Dietitians working in educational or community situations were more positive about integrating sustainability issues. Facilitating factors included: Dietitians that had experience in advocating for sustainable nutrition (n = 8), practicing in a setting committed to environmental issues (n = 8), attending events focused on sustainable nutrition (n = 7), access to training (n = 6), managerial support (n = 5), and involvement in networks (n = 5).  

4. Health system characteristics and practice settings:  
The need to promote sustainable nutrition with the general population was frequently reported (n = 11). The authors note that this would help to shift societal perspectives and practices and thus increase the legitimacy of incorporating sustainable nutrition.  Respondents also frequently reported the need for operational guidelines on sustainable nutrition tools to translate it into practice, and improved labelling laws (n = 10).  Regarding the latter, respondents noted the need for consistent information for consumers to be able to identify products consistent with sustainability principles. Lack of financial support was noted as a barrier (n = 6) in relation to training, food costs, research and program development.  

Overall, the authors suggest that the results underscore previous studies showing that for implementation by organizations and individuals, sustainable nutrition practices must be institutionalized (e.g., policies, certifications, guidelines). The literature also shows that even when practices are adopted, they can be superficial or symbolic, instead of changing internal practices through managerial support, resources, the development of competencies, planned integration, setting practice expectations and providing indicators for monitoring progress.  

Of additional interest: 

Of the studies not focusing on Dietitians, two studies were conducted with food service managers, and one with public health officers. Hospital food service managers suggested that due to a low consumer awareness of sustainable nutrition, much more attention was focused on human health. They also reported a need for clearer labelling and more available and accurate product information. Due to cost constraints, they often focused on specific aspects of sustainable nutrition (e.g., purchasing local products). This may be a way to slowly integrate sustainability, but could be problematic if it leads to complacency and more systems-based steps are not taken. Finally, they identified the need to identify key targets and specific indicators for monitoring sustainable nutrition advancement in hospitals. The study with public health officers also noted the need to systematically monitor changes at the local food system level using common metrics such as the percentage of sustainably or locally sourced foods.  

The authors noted that context is crucial to consider in the promotion of sustainable nutrition. For example, for some Indigenous residents in Northern Canada, hunting for meat is likely more environmentally sustainable and culturally appropriate than produce flown into communities.  

Editor’s comment:  

A table of definitions for each factor was not included in the article. 

Open access link to article: 

N/A 

Conflict of interest/ Funding: 

N/A  

External relevant links: 

N/A 

Indigenous voices and knowledge systems – promoting planetary health, health equity, and sustainable development for future generations (2019)

Citation: Ratima M, Martin D, Castleden H, Delormier T. Indigenous voices and knowledge systems – promoting planetary health, health equity, and sustainable development now and for future generations. Glob Health Promot. 2019 Apr;26(3_suppl):3-5. doi: 10.1177/1757975919838487. PMID: 30964406.

Relevant to: 

Public health Dietitians-Nutritionists working in any type of health promotion and/or climate action. 

Question: 

This editorial comments on the collection of papers in the supplement issue of the Global Health Promotion Journal “Whenua Ora: Healthy Lands, Healthy Peoples” (2019).  

Bottom line for nutrition practice: 

Long term solutions for sustainability require a paradigm shift away from Western reductionist and individualistic approaches toward Indigenous perspectives of the interconnectedness between humanity and the natural world.  

Abstract:

N/A

More details: 

The editors argue that as the planet’s ecosystem continues to deteriorate, a shift away from Western anthropocentric perspectives which separate humans from the natural world is inevitable. While, in theory, Health Promotion links humanity and the natural environment, the authors argue that the discipline has not made the shift to this holistic perspective that is characteristic of many Indigenous paradigms. They further suggest that Indigenous perspectives which emphasize interdependence and reciprocal stewardship with the natural world offer solutions for health promotion and sustainability.  

While the editors state that Indigenous Health Promotion (IHP) has developed over millennia, they suggest that contemporary IHP was motivated by a “need to make space for Indigenous ways of being, knowing and doing”. They outline concepts central to IHP, including: “self-determination; land-based learning; decolonization; health equity; environmental sustainability; cultural and linguistic integrity; and resurgence”. Ancestral land is key to IHP as a “point of connection between the past, present and future generations, as a source of identity and spiritual connection, and as a place that fosters community participation and cohesion” (p.4). While IHP is Indigenous led, the authors suggest that non-Indigenous Health Promotion researchers and practitioners are needed to support self-determined IHP.  

Of additional interest: 

A synopsis of “Climate change and Indigenous Health Promotion” from this supplement, is also included in this collection of papers. 

Editor’s comment: 

N/A 

Open access link to article:

N/A 

Conflict of interest/ Funding: 

None declared.  

External relevant links: 

Link for the entire journal supplement, however it is not open access:  
https://journals.sagepub.com/toc/pedb/26/3_suppl 

For the International Union for Health Promotion and Education 2019 Legacy documents from the conference that this journal supplement is associated with, see: https://www.iuhpe.org/index.php/en/iuhpe-world-conferences-on-health-promotion/23rd-world-conference/1340-iuhpe-2019-legacy-documents (English, French, Spanish, and other languages upon request).  

Sustainability: nutrition and dietetic students’ perceptions (2020)

Citation: Burkhart S, Verdonck M, Ashford T, Maher J. Sustainability: Nutrition and Dietetic Students’ Perceptions. Sustainability. 2020; 12(3):1072. https://doi.org/10.3390/su12031072 

Relevant to: 

Dietetic and nutrition educators. 

Question:

This Australian study explored nutrition and dietetic undergraduate students’ self-reported views and actions related to sustainability, with a view to building a holistic curriculum that includes content and competencies required to address UN Sustainable Development Goals. 

Bottom line for nutrition practice:

The researchers report that while students showed a high level of awareness of the general importance of sustainability, their knowledge related to it was superficial. The authors also suggest that their findings of strong core beliefs and values in students related to sustainability could motivate interest in further learning about the issues. The authors discuss and suggest systemic pedagogical approaches.   

Abstract:

Opportunities exist for nutrition and dietetic (N&D) professionals to contribute to sustainable development and support actions towards the attainment of the UN’s Sustainable Development Goals (SGD’s). Students undertaking higher education are well-placed to develop skills and capabilities in creative and critical problem solving for sustainability. However, there is limited literature exploring nutrition and dietetic students’ perceptions of sustainability that would help to inform an effective and constructively aligned embedding of sustainability content and active learning opportunities into curriculum. This descriptive cohort study design utilised a 17-question online survey to explore 95 Australian N&D undergraduate students’ self-reported familiarity with and perceived importance of sustainability and related concepts, and view of sustainability for future practice.

Participants reported being more familiar with the term environmental sustainability and related concepts than economic or social sustainability. Varying levels of familiarity of 42 sustainability related concepts within economic resilience, environmental integrity, social development and cross-cutting issues were reported. Most participants (82%, n=78) reported sustainability was very important in general (82%, n=78), and for professional practice (63%, n=60). Over half of the participants identified government led initiatives to address the future of society (65%, n=71). Our study highlights the complexity of sustainability in a discipline specific context and the need for understanding students’ perceptions of sustainability to inform N&D curriculum design. 

Details of results:

Most nutrition and dietetic students (82%) reported that sustainability in general is a very important issue, and the majority (92.5%) reported that it is very important or important to their future practice. Ninety-seven % were familiar with the term sustainability. Seventy-five % were very or quite familiar with environmental sustainability, compared to 47% for economic and 22% for social sustainability. When delving deeper into concepts related to these three terms, over 75% were familiar with the concepts of highly processed foods (environmental); secure livelihoods (economic); and the relationship between local foods and the economy (economic).  

On the other hand, students were less familiar with the use of food and agriculture policies (41.1%); labour rights (28.3%); national and global level food security (27.4%), social justice in the food system (25.3%); living conditions of farm labourers (41.1%), farmland protection (35.5%); economic viability of the agriculture sector (37.2%); resilience to economic risk (37.2%), opportunity to contribute to local or global markets (29.5%); preservation of rural communities (28.4%) and social capital (27.4%).  

Half of the students reported that sustainability often or always influenced their daily decisions. Students also indicated a need for government led sustainability initiatives. 

The authors suggest that their findings support the idea of embedding holistic, systems thinking and other pedagogical approaches across the curriculum in order to lay a foundation to understand the relationships between sustainability and nutrition and dietetics. Consistent use of language across courses is also important. 

 Of additional interest:

The authors suggest that a program curriculum mapping exercise to embed sustainability may be well received by students.   

Editor’s comment: 

N/A 

Open access link to article: 

https://www.mdpi.com/2071-1050/12/3/1072 

Conflict of interest/ Funding: 

none declared  

External relevant links: 

N/A