Limiting vs. diversifying patterns of recommendations for key protein sources emerging: a study on national food guides worldwide from a health and sustainability perspective

de Boer J, Aiking H, Limiting vs. diversifying patterns of recommendations for key protein sources emerging: a study on national food guides worldwide from a health and sustainability perspective. British Food Journal. 2021 (e-first ahead-of-print(ahead-of-print)

Relevant to: 

Dietitians-Nutritionists working in policy development or research related to food based dietary guidelines (FBDG).  


This study examined patterns of protein-related recommendations within FBDG. The researchers used information gathered from the from 93 countries with FBDG listed on the FAO website (see link below). They then explored how these patterns are related to specific contexts and social priorities of the countries as specified by country level variables, including their protein supply. Protein supply was estimated using food balance data from 2019 FAO data.   

Bottom line for nutrition practice: 

The authors propose that strong incorporation of sustainability principles into FBDG would help to legitimize the shift toward sustainable diets within society. They suggest that protein recommendations are a crucial component of shifting toward a sustainable diet, and that this is the first study to explicitly investigate protein intake within messages.  

This study found two emerging patterns: i) countries with combined positive advice about key protein sources with limiting messages to reduce or replace animal-based protein, and ii) countries that encouraged both animal and plant protein, with no negative advice on animal based protein. While these were associated with country level variables (see “Details of Results”), the study does not promote one style of recommendations over another.  

The authors also suggest that more explicit inclusion of sustainability messaging is important, but rarely included. 


Purpose – A shift to a healthy and sustainable diet (as recommended by the EAT Lancet Commission) needs to have a strong societal legitimation. This makes it relevant to investigate to what extent countries are using their Food-Based Dietary Guidelines (FBDGs) in ways that can stimulate such a shift. Design/methodology/approach – Given the pivotal role of protein, the authors examined what patterns of protein-related recommendations are used to guide consumers and how these patterns are related to specific contexts and societal priorities of the countries.  

Findings – The analysis of data from 93 countries worldwide revealed two emerging patterns of recommendations. One pattern (found in a cluster of 23% of the countries) combined positive advice about key protein sources with limiting messages to reduce (or replace) the consumption of animal protein. The other pattern (found in a cluster of 24%) encouraged both animal and plant protein, thereby diversifying the set of protein sources, without negative advice on animal-based food sources. The two patterns of recommendations were differently associated with health and nutrition variables, including the countries’ level of animal protein supply (in particular, dairy) and the prevalence of overweight individuals among adult men.  
Social implications – For all stakeholders, it is of crucial importance to realize that an increasing number of countries in the world are moving in the direction of acknowledging and addressing the diet-health- environment nexus by adapting their patterns of recommendations for key protein sources. Originality/value – This study is the first that reveals patterns in recommendations with respect to protein sources by different nations worldwide.  

 Details of results: 

Two emerging patterns were found. The first pattern combined positive advice about key protein sources with limiting messages to reduce or replace animal-based protein (23% of countries). This was referred to as a limiting pattern. It was found in many high income/ Western countries, and was associated with country-level variables including: a higher animal protein supply per capita, higher GDP, higher levels of urbanization, higher levels of environmental performance and higher levels of overweight amongst adult men. The authors also note that FBDG with more limiting messages were often more recently published, but that this may reflect past efforts to reduce animal fat intake.  

The second pattern (24% of countries) encouraged both animal and plant protein, with no negative advice on animal-based protein.  This was referred to as a diversifying pattern. It was found in East Asia and also some high income/ Western countries. The researchers noted that this advice differed within this group between countries that had low, and countries with high animal protein supplies. They suggested that in countries with low protein supplies that this advice may have resulted from necessity. In other countries , it resulted from the intent to have only positively formulated FBDG recommendations. This pattern was not associated with the variables noted within the first pattern, but correlated somewhat positively with the supply of plant based protein, and higher populations. 

The authors further state that about half of the countries made few protein related recommendations, and those made were mostly related to legumes and dairy. This included countries with a low or medium animal protein supply, mostly in sub-Saharan Africa and Latin America. This pattern was associated with a high number of overweight women (see of additional interest).  

Finally, the authors note that they found little direct reference to sustainability or the environment in the FBDG reviewed, and that this is needed in order to stimulate discussion about sustainable diets as well as to acknowledge the urgency of this issue.  

 Of additional interest: 

The Latin America and Caribbean regions had the highest level of overweight among adult women. The author cite other research showing that overweight with men and overweight with women are different due to biological and cultural factors. As such, overweight in women is higher compared to men in low and middle income countries, whereas men have higher rates of overweight and obesity than women in high income countries.  

FAO website on food based dietary guidelines: 

Editor’s comments:  

The correlation of FBDG messages to the contextual and social variables such as national health, environmental, economic (including food supply) appears novel; further examination of these correlations may be of interest for other researchers.   

The authors stated that there were “almost no explicit references to sustainability or the environment” (p.11), although – at a minimum – countries such as Sweden, Brazil and Qatar include these types of messages. How they analyzed this is not evident within the paper. However, perhaps this observation was due to their noted limitation that they only used information listed on the FAO website. Further, they were not specific about whether they used only the summaries on the FAO site, rather than viewing the original sources; original sources may include full documents versus shortened guidelines that may be represented on the website.  

Open access link to article: 


Conflict of interest/ Funding: 


External relevant links: 


Corresponding author: 

Joop de Boer can be contacted at:  

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