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Optimizing sustainable, affordable, and healthy diets and estimating the impact of plant-based substitutes to milk and meat: A case study in Spain (2023 Sep)

Muñoz-Martínez, J., Abejón Elías R., Batlle-Bayer, L., Cussó-Parcerisas, I., Carrillo-Álvarez, E. (2023) Optimizing sustainable, affordable and healthy diets and estimating the impact of plant-based substitutes to milk and meat: A case study in Spain. Journal of Cleaner Production. Volume 424. https://doi.org/10.1016/j.jclepro.2023.138775. (paid access)

Relevant to: 

Dietitians and public health nutritionists, Health care professionals, Policy makers

Question: 

How is an environmentally sustainable, affordable, culturally acceptable, and nutritious diet determined in Spain? What is the sustainability of current Food-Based Dietary Guidelines (FBDG)? How much can we rely on plant-based milk and plant-based meat from a sustainability perspective ?

Bottom line for nutrition practice: 

  • It is paramount to evaluate the sustainability of diets from a holistic and context-based perspective. Our analysis revealed that although the Spanish FBDG have lower Greenhouse Gas emissions (GHGe) than current diets, they are more blue-water demanding and also more expensive due to the high content in plant-based foods.
  • We were able to determine a nutritious diet with the lowest environmental impact and lowest cost, but results revealed the need to apply actions at systems level to enable more environmentally respectful production practices, and make healthy foods more affordable.
  • Processed plant-based meat alternatives are not required to achieve a sustainable and healthy diet.

Abstract: 

  • The global food system is failing to appropriately nourish the population and has been identified as a driving force for environmental degradation. Changing current diets to healthier and more sustainable ones is key to decrease the incidence of non-communicable diseases and force changes at the production stage that will release environmental pressure. The determination of such diets is a challenge since it should be context specific, culturally acceptable, affordable, nutritionally adequate, and environmentally friendly.
  • Through multiobjective optimization we aimed to determine a sustainable and healthy diet (SHD) in Spain with the minimum cost and environmental impact (assessed through GHGe, land use and blue-water use) that deviate the least from current consumption. Additionally, this research also compares the optimised diet with the Spanish food-based dietary guidelines (FBDG), and explores the potential benefits of reducing animal meat and milk while replacing them with plant-based alternatives. Compared to current consumption, a SHD in Spain can be more nutritious and reduce cost, GHGe, land and blue-water use by 32%, 46%, 27%, and 41%, respectively.
  • The Spanish intake displayed the worst nutritional assessment and the highest values for GHGe and land use. The Spanish FBDG showed the highest cost and blue-water usage. Further analysis revealed that plant-based meat alternatives are not necessary to achieve a nutritionally adequate diet at the minimum cost and environmental impact. Shifting to fortified plant-based milk alternatives may add additional environmental benefits.
  • This work emphasizes the potentiality of using optimization to determine a SHD and identifies important gaps to be fulfilled in future research.

Details of results: 

  • Compared to the Spanish intake, a nutritionally adequate sustainable and healthy diet can be 1.61 € cheaper, reduce GHGe by 2.33 kgCO2eq, land use by 1.5 m2, and blue water use by 156 L. 
  • The Spanish FBDG basket was the most expensive and blue water demanding, mainly explained by the high content of fruits and vegetables. 
  • The Spanish intake showed the lowest nutritional index and the highest GHG and land footprint due to the high content of animal protein.

Of additional interest: 

Conflict of interest/ Funding:  

None

Corresponding author: 

Júlia Muñoz Martínez, juliamm1@blanquerna.url.edu

Summary: Equipping nutrition graduates for the complex realities of practice: Using practitioner perspectives and experiences to inform authentic sustainability curriculum (2023)

Maher, J, Ashford, T, Verdonck, M, English, E, Burkhart, S. Equipping nutrition graduates for the complex realities of practice: Using practitioner perspectives and experiences to inform authentic sustainability curriculum. J Hum Nutr Diet. 2023; 1– 11. https://doi.org/10.1111/jhn.13159

Open access link to article:

https://onlinelibrary.wiley.com/doi/10.1111/jhn.13159

Relevant to:

Dietitians, Practitioners, Nutrition students, Nutrition graduates

Questions the research focuses on:

How do a cohort of Australian N&D professionals perceive opportunities for integrating sustainability into practice? What are the challenges or barriers to realizing these?

Bottom line for nutrition practice:

We recognize practitioners as a source of experience, anticipating where sustainability discourse and nutrition practice intersect.

Abstract:

Background: Nutrition professionals’ function at the nexus of food, nutrition status and the myriad of determinants influencing these. However, defining our role in food system transformation requires a multifaceted and deep understanding of sustainability in the context of nutrition and dietetics (N&D). Practitioner perspectives and experiences provide a rich source of practice wisdom that can inform authentic curriculum to equip students for the complex realities of practice; however, there is limited understanding of these in the Australian higher education setting.

Methods: Qualitative methodology using semi structured interviews with 10 Australian N&D professionals. Thematic analysis was used to understand how they perceive opportunities and barriers for integrating sustainability into practice.

Results: Practitioners’ experience in sustainability practice varied. Themes were identified in two categories: opportunities and barriers. Themes that reflected future practice opportunities included “Preparing the workforce” (for academics and practitioners interfacing with students), “Practical individual level work” and “System level and policy interests”. Themes that were considered barriers to integrating sustainability in practice included “lack of contextual evidence” and “complexity and competing priorities”.

Conclusions: Our findings make a novel contribution to the current literature as we recognise practitioners as a source of experience anticipating where sustainability and nutrition practice intersect. Our work provides practice-informed content and context that may assist educators to create authentic sustainability-focused curriculum and assessment to replicate the complexity of practice.

Details of results:

  • Practitioners found it difficult to name specific examples of sustainability in practice, possibly because of the current landscape where there is a lack of consensus on what sustainability in nutrition and dietetic practice is.
  • Integrating sustainability into nutrition practice was associated with two themes categorized as barriers. These were: a lack of contextual evidence, complexity and competing priorities.
  • Integrating sustainability into nutrition practice was also associated with three themes for opportunities: learning and teaching practice to prepare the workforce; individual-level practice and application; and broader system/policy-level practice.
  • The results show that opportunities and barriers are interconnected, and it is likely that the perceived opportunities can be realized if sectorial, institutional, and government policies change and the profession advances and adapts.
  • Preparing students for practicing with a sustainability lens requires integration of sustainability in its various forms into N&D curriculum and equipping them with the skills and capabilities to contribute meaningfully to N&D practice from an individual to food system level.
  • Knowledge alone may not equip graduates to effectively practice for human and planetary health. Moving forward, practice insights provide a productive platform for curriculum development, both situating practice within the current complex contexts or “realities” at the same time as also considering a future that integrates sustainability and nutrition more closely.
  • There is a predominant environmental focus that may limit the effectiveness of student training, particularly in addressing more challenging and complex situations or settings where environmental concerns must also be balanced with social and economic realities.
  • If governments or institutions have not yet included sustainability within their policies, curriculum developers can. This will then shift the expectation of N&D graduates who may be able to advocate for change from inside government and institutions.

Of additional interest:

⇾ ICDA Learning Modules – These three learning modules are structured to support your knowledge in:

  1. understanding foundational concepts of sustainability and food systems,
  2. understanding the relevance of SFS to nutrition and dietetic practice, and
  3. being able to apply SFS concepts in your practice.

⇾ NDA SFS Position Papers – Several nutrition and dietetics associations are officially recognising the relevance of Sustainable Food Systems (SFS) and/or sustainable diets to nutrition and dietetics practice.

⇾ SFS Education in Nutrition & Dietetics degrees: Global Case Studies – International Dietetic educators integrating sustainability into their curricula. The is an online platform for sharing examples serves as a series of mini case studies

⇾ Teaching Food Systems and Sustainability in Nutrition Education and Dietetic Training: Lessons for Educators (2013) – This is a PDF compilation of research and experiential lesson plans from food, nutrition and dietetic educators in the US and Canada.

⇾ The Food Sustainability Index (FSI) as an Educational Tool (2016) – The FSI has an intended audience of university students and graduate students, by can be used for anyone who interested in learning more about the connection of food and nutrition to sustainable food systems and the Sustainable Development Goals.

⇾ Sustainability: nutrition and dietetic students’ perceptions (2020) – 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.

⇾ Leveraging Online Learning to Promote Systems Thinking for Sustainable Food Systems Training in Dietetics Education (2021) – A multidisciplinary group of educators, learners, and food systems experts representing eight different institutions across the US worked together over one year to develop, pilot test, and evaluate two interactive webinar series. The series was provided for dietetics interns and graduate students at four university sites in the United States between March and May 2019.

⇾ Summary: How do dietetics students learn about sustainability? A scoping review (2023) – Despite increasing discussion about the role of dietitians in supporting sustainable food systems, effective integration into dietetics curricula is understudied. Some evidence points to the importance of experiential learning, and scaffolded learning about SFS through integration into a number of different courses.

Conflict of interest/funding:

The authors declare that there are no conflicts of interest.

Corresponding author:

Judith Maher, Doctor of Philosophy (Nutrition and Dietetics), jmaher@usc.edu.au

Summary: How do dietetics students learn about sustainability? A scoping review (2023)

McCormack, J., Rutherford, S., Ross, L. J., Noble, C., & Bialocerkowski, A. (2023). How do dietetics students learn about sustainability? A scoping review. Nutrition & Dietetics. https://doi.org/10.1111/1747-0080.12795

Link to the article

Open Access: https://onlinelibrary.wiley.com/doi/epdf/10.1111/1747-0080.12795

Relevant to:

Dietetic Educators, Dietitians, Dietetic Students

Questions the research focuses on:

  1. What teaching approaches and evaluation strategies have been used to underpin the learning activities focused on sustainability in dietetics entry-level curricula?
  2. What are the learning outcomes of these activities based on the Kirkpatrick-Barr framework?
  3. Have the UNESCO and Commonwealth Secretariat recommendations translated into the delivery of sustainability content in nutrition and dietetics entry-level curricula based on articles published since their development?

Bottom line for nutrition practice:

Despite increasing discussion about the role of dietitians in supporting sustainable food systems, effective integration into dietetics curricula is understudied. Without clear competencies and guidance, educators are doing this ad hoc. More guidance is needed. Some evidence points to the importance of experiential learning, and scaffolded learning about SFS through integration into a number of different courses.

Abstract:

Aim: Globally, sustainability and planetary health are emerging as areas of critical importance. In 2015, the 2030 Agenda for Sustainable Development was adopted by the United Nations member states. Since then, the United Nations Educational, Scientific and Cultural Organization and the Commonwealth Secretariat have published guidelines for educators to embed sustainability content into curricula. This scoping review aims to identify how student dietitians learn about sustainability, how learning opportunities are evaluated, their outcomes, and whether these guidelines have translated into teaching activities contained in dietetic degrees.

Methods: A scoping review was used to address the aims. Eight electronic databases and Google Scholar were searched from inception to March 2022 for articles describing dietetics students’ participation in learning activities focused on sustainability. Data that addressed the research aims were charted independently by two researchers, then narratively synthesized.

Results: Twelve articles met the inclusion criteria. A range of teaching approaches and evaluation methods were used, from passive learning in lectures to experiential learning activities. A change in knowledge or behaviour was found for experiential learning activities (n = 5). For articles published after 2015 (n = 9), two mentioned the Sustainable Development Goals and no articles referenced the published guidelines.

Conclusions: A paucity of evidence exists describing how dietetics students learn about sustainability and their learning outcomes. Of the 12 articles published, varied teaching approaches and evaluation methods have resulted in inconsistencies in the reporting of outcomes. The minimal reference to the Sustainable Development Goals and published guidelines suggests a slow translation of knowledge to practice.

Details of results:

  • The database search yielded 1363 unique items. A total of 12 articles met the inclusion criteria and were therefore included in this scoping review. With 12 articles found, each used a unique method. This variety in both the teaching approach and evaluation makes it difficult for dietetics educators to choose an approach that maximizes the knowledge and skills attained by students.
  • Given the drive to upskill both students and dietitians alike in this critical area of practice, longer-term outcomes should be measured. Arguably, the depth and complexity of the knowledge required to develop dietetics students who are competent in this area cannot be taught in one course and requires the development of knowledge and skills to occur over a longer time period. This aligns with recommendations made by UNESCO and the Commonwealth Secretariate that suggest scaffolding content across multiple courses to develop key competencies. UNESCO recommends that educators embed an action-oriented, transformative pedagogy, that is scaffolded across the curriculum, and not contained in a stand-alone course.
  • Based on this review, only three articles referred to the Sustainable Development Goals, and no articles referred to the UNESCO or Commonwealth Secretariat Guidelines.
  • Without clear competencies from professional bodies and guidance on what to include in the curriculum, academics with an interest in sustainability may add content only when necessary.
  • Based on this review of peer-reviewed and grey literature, there is limited literature to describe how student dietitians are learning about sustainability within their dietetics education programs. The variable teaching approaches and evaluation methods used have resulted in inconsistencies in the reporting of outcomes, and the minimal reference to the Sustainable Development Goals and other published guidelines suggests a slow translation of knowledge to practice in the higher education setting.

Of additional interest: 

Conflict of interest/ funding:

Open access publishing facilitated by Griffith University, as part of the Wiley – Griffith University agreement via the Council of Australian University Librarians. The authors declare no conflicts of interests.

Corresponding author:

Joanna McCormack, Accredited Practising Dietitian (APD) j.mccormack@griffith.edu.au

Food and food-related waste management strategies in hospital food services: A systematic review (2022)

Cook N, Goodwin D, Porter J, Collins J. Food and food-related waste management strategies in hospital food services: A systematic review. Nutrition & Dietetics. 2022;1‐27. doi:10.1111/1747-0080.12768COOKET AL.27

Open access link to article: 

https://onlinelibrary.wiley.com/doi/full/10.1111/1747-0080.12768

Relevant to: 

Foodservice dietitians, sustainability dietitians, foodservice manager and workers

Question: 

  • What are hospital foodservices around the world currently doing to manage their food waste more sustainably?
  • What are the financial, environmental and staffing outcomes associated with these activities?
  • And what were the barriers and enablers to implementing these strategies?

Bottom line for nutrition practice: 

  • Divert surplus edible food and inedible food waste from landfill by using the most appropriate management strategy available.

Abstract: 

  • Aim – This review explored peer-reviewed and grey literature to describe the types and characteristics of food or food-related waste management strategies used in hospital food service settings; their financial, environmental and staffing outcomes; and the barriers and enablers associated with their implementation.
  • Methods – Six electronic databases, 17 Google Advanced searches, and 19 targeted websites were searched for peer-reviewed and grey literature. Literature reporting the financial, environmental, or staffing outcomes of food or food-related waste management strategies that reused, recovered energy from, or recycled waste instead of sending it to landfill were eligible. Document screening and review were completed in duplicate, and included peer-reviewed literature were assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesised narratively.
  • Results – Four peer-reviewed and 81 grey literature records reported 85 strategies. When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21); feeding animals (n = 2); industrial use (n = 11); composting (n = 34) and other (n = 17). These approaches had the capacity to reduce waste hauling fees (n = 14), reduce staff handling of waste (n = 3), and decrease the amount of waste sent to landfill (n = 85). Barriers included contamination of waste streams, while enablers included leadership and time-neutral changes.
  • Conclusion – This review summarises the waste management strategies used by hospitals worldwide that divert food and food-related waste from landfill, their outcomes, and position in the food recovery hierarchy to enable hospital food services to implement appropriate practice and policy changes to decrease their environmental footprint.

Details of results: 

  • 85 examples of hospital foodservices were found to be diverting their food waste from landfill more sustainably.
  • When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21); feeding animals (n = 2); industrial use (n = 11); composting (n = 34) and other (n = 17).
  • The location of these strategies diverting waste were in hospital foodservices (n = 41), cafeteria (n = 7), CPK (n = 2), catering unit (n = 1) or combination of these settings (n = 18).
  • Financial savings ranged from AUD $400-50,000 from waste disposal, equipment changes and labour use whereas costs ranged from AUD $1200-260,500 from food waste collection and installing procured equipment.
  • Landfill savings occurred in every case but notably the highest examples were annually: 18,1444 kgs being donated, 200 tons composted and 360 digested.
  • Other environmental outcomes included reduced carbon emissions, water savings, energy creation and less transport.
  • Staffing outcomes were less waste handling and less time cleaning, however also involved giving staff more responsibility to separate, transport waste and operate equipment.
  • The major reported barriers were contamination, times demands, equipment problems, stakeholder coordination and staff resistance, whereas enablers were leadership, no increase in time, easy equipment use, data and a return on investments.

Of additional interest: 

Collection of research on food waste measurement by this group on Google Scholar

Conflict of interest/ Funding:  

Prof. Judi Porter is Editor-in-Chief of Nutrition & Dietetics. She was excluded from the peer-review process and all decision making regarding this article. This manuscript has been managed throughout the review process by the Journal’s Editor. The Journal operates a blinded peer review process and the peer reviewers for this manuscript were unaware of the authors of the manuscript. This process prevents authors who also hold an editorial role to influence the editorial decisions made. All authors are in agreement with the manuscript and declare that the content has not been published elsewhere. Other authors declare no conflicts of interest. NC received a departmental scholarship for his Ph.D. from Monash University’s Department of Nutrition, Dietetics and Food, and a King and Amy O’Malley Trust Scholarship during this study.

External relevant links:  

USA EPA Food recovery hierarchy.

Corresponding author: 

Mr. Nathan Cook, Nathan.cook@monash.edu

Factors influencing implementation of food and food-related waste audits in hospital foodservices (2022)

Cook N, Collins J, Goodwin D and Porter J (2022) Factors influencing implementation of food and food-related waste audits in hospital foodservices. Front. Nutr. 9:1062619. doi: 10.3389/fnut.2022.1062619

Open access link to article: 

https://www.frontiersin.org/articles/10.3389/fnut.2022.1062619/full

Relevant to: 

  • Foodservice dietitians, sustainability dietitians, foodservice manager and workers

Bottom line for nutrition practice: 

  • What are the perspectives of individuals working close or within hospital foodservices on a previous developed food waste audit tool and what do they perceive to be the major factors supporting and or blocking the completion of a food waste audit?
  • Consider the barriers and enablers to the completion of a food waste audit in your facility before pursuing one including the design, completion and analysis of an audit.

Abstract: 

  • Background: Designing a food waste audit tool for novel hospital foodservice practice does not guarantee uptake. Intended users must be consulted to understand the tool’s feasibility and face validity. This study aimed to identify the perspectives of staff involved in the operation of hospital foodservices on (1) how an evidenced based consensus pathway food waste audit tool is perceived to translate into practice, and (2) to determine the factors that influence the completion of food and food-related waste audits within this setting.
  • Materials and methods: Purposeful sampling was used to recruit staff with knowledge on the operation/governance of foodservices within hospitals in Victoria, Australia. Semi-structured interviews (n = 20) were conducted via Zoom to explore barriers and enablers to completing food and food-related waste audits and a previously published food waste audit tool. NVivo was used for inductive thematic analysis.
  • Results: Three factors determined the completion of food and food-related waste audits in hospital foodservices, and each factor could be a barrier or an enabler; (1) capacity: the availability of time, labour and materials to complete an audit (2) change: staff resistance to audit procedures and how to gain their buy-in (3) processes, governance, and leadership: the opportunity for high level support, policy and structure to encourage waste audits if present. The consensus tool appeared to have face validity. Planning audit operations, conducting stakeholder meetings, providing education/training to foodservice team members, and facilitating communication between managers and staff were described to support consensus tool use and audit completion.
  • Conclusion: The consensus tool can be used to support hospital foodservices to complete food and food-related waste audits, although it may need to be customised to be fit for purpose. Optimising the capacity, change management and processes, governance and leadership of the foodservice department may improve the experience and success of a food and food-related waste audit.

Details of results: 

  • The two major perspectives participants shared for a food waste audit to come to fruition were appropriate preparation and implementation. Other recommendations included adequate support, having a clear goal in mind, planning, organising logistics and having clear communication between all levels of staff delivered through meetings and education sessions.
  • Most of participants believed the tool was: detailed, supportive to their practice, helpful for decision making and ready to use. However others viewed it as busy, confusing and that it requires extra knowledge to understand and use. Future iterations of the tool were suggested to be customisable to participants facilities, demonstrate solutions to reduce food waste and have separate sections compared to the one page only.
  • The three factors relating to food waste audit completion were –
    • (1) capacity: the availability of time, labour and materials to complete an audit.
    • (2) change: staff resistance to audit procedures and how to gain their buy-in.
    • (3) processes, governance, and leadership: the opportunity for high level support, policy and structure to encourage waste audits if present.
  • A key finding related to the factors which may support or hinder a food waste audits completion were that the enablers suggested would solve the barriers discussed. This demonstrates individuals who work close or within hospital foodservices already know what to do for a food waste audit if this task was asked of them to complete.

Of additional interest: 

Collection of research on food waste measurement by this group on Google Scholar.

Conflict of interest/ Funding:  

No conflict of interest. NC received a departmental scholarship for his Ph.D. from Monash University’s Department of Nutrition, Dietetics and Food, and a King and Amy O’Malley Trust Scholarship during this study

External relevant links:  

Corresponding author: 

Mr. Nathan Cook Nathan.cook@monash.edu

The importance of food systems and the environment for nutrition (2020)

Fanzo J, Bellows AL, Spiker ML, Thorne-Lyman AL, Bloem MW. The importance of food systems and the environment for nutrition. The American Journal of Clinical Nutrition. 2020;113(1):7-16.

Open access link to article: 

https://pubmed.ncbi.nlm.nih.gov/33236086/

Relevant to: 

Dietitians-Nutritionists involved in research to advance sustainability in global food systems and nutrition.

Question: 

The authors identify research and information gaps needed to transition nutrition and food systems toward sustainability and put out a call from the American Journal of Clinical Nutrition (AJCN) for innovative food systems research. They also provide an overview of the rationale for the transition.

Bottom line for nutrition practice: 

  • Climate change and environmental degradation affect human health by impacting clean air, drinkable water, food safety and exposure to pathogens, and the ability to produce and gather plant and animal-based foods. These impacts have a disproportionate effect on poor and marginalized populations, further increasing equity gaps in nutrition and health outcomes.
  • Environmental changes are both drivers of changes in food systems, and also impact food and agricultural outcomes; this results in a feedback loop. For example, greenhouse gas emissions from agricultural production impact climate temperatures, which in turn impact food production.
  • The authors maintain that nutrition professionals have a broad expertise and are well positioned to collaborate with other disciplines in order to further sustainable food system practices (e.g., reducing food loss and waste, advancing sustainable agricultural practices, and forwarding sustainability in food services and food environments).
  • They identify numerous gaps in knowledge – including the need for a greater understanding of the relationship between agriculture, food value chains, climate, environment, diet, nutrition, and human health, as well as how a transition can be made (e.g., what are effective public health and policy interventions to advance sustainable food systems?).

Abstract: 

  • Global and local food system transformation is necessary in order to ensure the delivery of healthy, safe, and nutritious foods in both sustainable and equitable ways. Food systems are complex entities that affect diets, human health, and a range of other outcomes including economic growth, natural resource and environmental resiliency, and sociocultural factors.
  • However, food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability. Although there has been increased focus on this topic in recent years, many gaps in our knowledge persist on the relation between environmental factors, food systems, and nutritional outcomes.
  • In this article, we summarize this emerging field and describe what innovative nutrition research is needed in order to bring about food policy changes in the era of climate disruption and environmental degradation.

Details of results: 

The authors present the case that climate change and environmental degradation will have severe impacts on human health. They cite research suggesting that low latitude areas of the globe will have reduced crop yields as a result of climate change, whereas higher latitude areas may have increased yields in the short term. Increasing CO2 in the environment may also impact the nutrient content of foods. Lower yields, instability, decreased micronutrient content and increased costs disproportionately threaten poor households.

Further, these differences across the globe may result in a greater reliance on global rather than local food supplies, which the authors suggest will further threaten equity, food sovereignty and sustainability of food systems. Increased temperatures will also cause an escalation of crop pests and pathogens, and toxic producing algal blooms in marine systems.

The authors argue that many knowledge gaps in our understanding exist and propose a conceptual framework to further examine human health, food systems and the environment. It consists of:

  • environmental inputs (e.g., soil quality, temperature, ocean acidification);
  • food system (i.e., food supply; food environment; consumer behavior);
  • proximal outcomes (i.e., food safety exposures; diet; food loss and waste);
  • distal outcomes (nutrition and health; environment (e.g., greenhouse gas emissions)).

The framework illustrates how distal outcomes in turn influence environmental inputs in a feedback loop. Knowledge gaps are outlined in more detail under components of their conceptual framework.

i. Environmental inputs and food system processes
As well as noting gaps such as research lacking on middle of the food supply chain (versus production and consumer dietary intake), the authors stress the need to understand more about designing food environments to advance health and sustainability. For example, including ecological footprint of foods, the amount and type of packaging used, eco- and health labeling on food packages, food sourcing origins and food safety information. They also stress that more research on policies and interventions that effectively incentivize healthy and sustainable diets is required – from both the position of consumer and of food supply chain stakeholders.

ii. Proximal outcomes of the food system

  • Diet: The authors identify the lack of data both in what people consume, and also in methods to test the effectiveness of interventions to advance healthy and sustainable diets.
  • Food safety in the food system: A paucity of data is noted in relation to human health effects and exposure to chemical and biological agents, including pesticide use and plastic packaging. They also highlight the importance of understanding consumer perceptions of pesticide, chemical, and antimicrobial exposure and how this may impact decisions on food purchasing.
  • Food loss and waste: The authors identify the need for more accurate data on food loss and waste as well as cost effective policies and interventions to reduce it (see: of further interest, FAO Food Waste Index).

iii. Distal outcomes of food systems:

  • Nutrition and health outcomes: The authors cite The Global Syndemic Commission (see: of further interest) where the “syndemic”—”the consequences of undernutrition, overweight/obesity, and climate change”—are presented as interconnected (p. 12). They also note that uncertainties remain about the impacts of environmental degradation and climate change on micronutrient deficiencies.
  • Environmental outcomes: The impacts of food systems on environmental outcomes differ by region and method of food production. Further, research to date centers more so on high income countries, greenhouse gas emissions, and livestock and staple grain products.

While the authors maintain that nutrition professionals are well positioned to address healthy and sustainable food systems, they also suggest that more data is required.

Further, they stress that different geographical, political, and societal contexts will greatly impact how the issues are addressed by stakeholders within various countries including professionals and governments.

Finally, this article is a call by the American Journal of Clinical Nutrition (AJCN) for cross-disciplinary, innovative food systems research that will inform action at various geographical levels across the globe.

Of additional interest: 

The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report (2019) https://www.thelancet.com/commissions/global-syndemic

FAO Food Waste Index (2021): https://www.unep.org/resources/report/unep-food-waste-index-report-2021

Editor’s comment:  

n/a

Conflict of interest/ Funding:  

The authors reported no funding received for this study.

Corresponding author: 

jfanzo1@jhu.edu

‘It’s a constant changing environment, and we’re just playing catch up’: Hospital food services, food waste, and COVID-19 (2022 Jun)

(available for download at the bottom)

Cook N, Goodwin D,Collins J, Porter J.‘It’s a constant changingenvironment, and we’re just playing catch up’:Hospital food services, food waste, and COVID-19.Nutrition & Dietetics. 2022;1‐10. doi:10.1111/1747-0080.12762

Open access link to article: 

https://onlinelibrary.wiley.com/doi/epdf/10.1111/1747-0080.12762

Relevant to: 

Foodservice dietitians

Question: 

The research wanted to understand the impacts of COVID-19 on hospital foodservice practices. Specifically, how COVID-19 impacted the completion of food waste audits and the generation of food waste in hospital foodservice.

Bottom line for nutrition practice: 

  • Foodservice staff are a resilient workforce group
  • Forced changes in resource allocation and usage allowed foodservices to adapt and learn to work with COVID-19 restrictions, potentially beginning the path to post-pandemic services.
  • This stage of the ‘green recovery’ can be led by dietitians and may incorporate food waste audits as a higher priority.
  • The success of electronic menu management tools during this period to combat contact restrictions may see them remain as ‘standard procedure’ for food waste data collection and be selected for uptake in additional hospitals who do not have this technology currently.

Abstract: 

  • Aims: Hospital food service operations have been affected by the COVID-19pandemic, particularly resulting in increased waste. The aim of this research was to explore the impact of the COVID-19 pandemic on hospital food ser-vices, particularly on food waste and the completion of food waste audits.
  • Methods: A qualitative interview research design was used. Semi-structured interviews were completed and recorded via Zoom, focusing on the barriers and enablers towards the completion of hospital food waste audits. Twenty-one participants were interviewed from 12 hospitals. No questions were related o the COVID-19 pandemic and its impact on hospital food services, however this issue frequently emerged during interviews. Data were coded following inductive thematic analysis.
  • Results: Five themes were generated from the interviews related to COVID-19and hospital food services; impacts on practice, labour, change, technology and post-pandemic expectations. Participants reported COVID-19 negatively affected food service operations. Changes included increased food waste, con-tact restrictions, and labour shortages. Nonetheless, hospitals embraced the challenge and created new positions, trialled different food waste data collection methods, and utilised technology to support food service operations around COVID-19 restrictions.
  • Conclusions: Despite the impact COVID-19 had on hospital food services, including their ability to audit food waste and increased food waste generation, the response from food services has demonstrated their adaptability to change. Sustainable healthcare, including the aggregate measuring and reduction of food waste in hospital food services, is an essential transition post-pandemic, and may be facilitated through the operational changes forced by COVID-19.

Details of results: 

Five themes were generated from the data after inductive coding was completed: these are below in dot point format with some of the dominant responses presented.

  1. Impacts on practice
    • Infection prevention led to increased pre-packaged single serve food, utensils, crockery and their waste
    • The re-use, storage, or donation of used items was prohibited
    • Waste disposed of in patient rooms
    • Forecasting was impacted by COVID peaks
  2. Change
    • Some changes occurred immediately, others took time
    • Reduction in hospital catering services
    • COVID-19 as an excuse to trialing new practice
    • Ingredients inaccessible and out of stock
  3. Technology
    • Room service was recommended to forecast meal numbers and support food service delivery
    • Electronic menu management systems with waste measurement capabilities were supportive in plate waste data collection but not available at all sites due to cost, equipment, and manual data collection still being part of standard practice
  4. Labour
    • Higher than usual sick leave
    • Failure to hire new staff (>300 interviews completed at one site)
    • Individuals forced to step in to new and unfamiliar roles (e.g. manager to chef)
    • Cumulative pressure on staff throughout COVID including vaccine mandate in Victoria which resulted in loss of staff
    • Nutrition students unavailable to hospitals for placement
  5. Post Pandemic expectations
    • Hope for practice to return to normal as soon as possible or when the pandemic is ‘over’
    • Planning for future emergencies already to counteract drastic changes in service and practice

Of additional interest: 

Editor’s comment:  

2022.10 Cook Decision tree tool explanationDownload

@nathan_cook includes the audit tool with descriptions for you available at this link in the side bar.

Conflict of interest/ Funding:  

One author of the research is an editor at the journal, however the journal undergoes a blinded peer review process. Funding was received by Nathan Cook in the form of a scholarship from the King and Amy O’Malley Trust Scholarship and the Department of Nutrition, Dietetics and Food at Monash University as part of his PhD.

External relevant links:  

A blog describing the research article – http://monashnutrition.blogspot.com/2022/09/hospitals-covid-food-waste-dilemma.html

Corresponding author: 

Nathan Cook, @nathan_cook, PhD candidate, nathan.cook@monash.edu

Development of an EAT-Lancet index and its relation to mortality in a Swedish population (2021 Nov)

Stubbendorff, A., E. Sonestedt, et al. (2021). “Development of an EAT-Lancet index and its relation to mortality in a Swedish population.” The American Journal of Clinical Nutrition.

Open access link to article: 

https://doi.org/10.1093/ajcn/nqab369

Relevant to: 

Community, Dietetic Educator, Public Health, Researcher

Question: 

We sought to develop a new dietary index to quantify adherence to the EAT-Lancet diet and assess its association with mortality in a large, population-based Swedish cohort.

Bottom line for nutrition practice: 

A large population study from Lund University in Sweden has shown that more sustainable dietary habits are linked to health benefits, such as a reduced risk of premature death from cardiovascular disease and cancer.

Abstract: 

  • Background – Current global food systems threaten human health and environmental sustainability. In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems defined the first global reference diet to improve both areas, but there is no consensus on how to quantify the EAT-Lancet reference diet as a diet index, and its relation to mortality has not been widely studied.
  • Objectives – We sought to develop a new dietary index to quantify adherence to the EAT-Lancet diet and assess its association with mortality in a large, population-based Swedish cohort. We also examined food components included in the index and their individual associations with mortality.
  • Methods – We used the Malmö Diet and Cancer cohort (n = 22,421; 45–73 years old at baseline). Dietary data were collected using a modified diet history method. The EAT-Lancet index was developed based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0–3 points per component; 0–42 points in total). Associations with mortality were examined based on registers during a mean of 20 years of follow-up and were adjusted for potential confounders.
  • Results – Divided into 5 adherence groups, the highest adherence to the EAT-Lancet diet (≥23 points) was associated with lower all-cause mortality (HR, 0.75; 95% CI, 0.67–0.85), cancer mortality (HR, 0.76; 95% CI, 0.63–0.92), and cardiovascular mortality (HR, 0.68; 95% CI, 0.54–0.84) than the lowest adherence (≤13 points). Several food components included in the index contributed to the observed reductions in mortality.
  • Conclusions – We developed a new dietary index to investigate adherence to the EAT-Lancet diet. The findings indicate a 25% lower risk of mortality among those with the highest adherence to the EAT-Lancet diet, as defined using our index, which adds to the evidence base for the development of sustainable dietary guidelines.

Details of results: 

Participants received between 5-35 points of the possible maximum of 42 points.

  • Mean score for women was 18.5 and 16.8 for men.
  • Less than 1% of the study population reached the target intake of the EAT-Lancet diet for legumes and nuts.
  • Less than 5% reached the target intakes for whole grains, beef and lamb, and pork.
  • Adherence was highest for poultry and fish, where 77% and 66% of the population reached the target intakes, respectively.
  • Comparing the group with the highest score to the lowest score shows a decrease in total mortality of 25%, cancer mortality of 24% and cardiovascular mortality of 32% in the fully adjusted model.
  • In the less adjusted model the magnitude of the results were even larger.
  • Adherence to each of the 14 food group components included in the EAT-Lancet index and mortality were also tested separately. High intakes of whole grains, vegetables, and fruits, compared to low intakes, were associated with lower risks of all-cause mortality, whereas high intake of eggs was associated with a higher risk.

Of additional interest: 

Scroll down👇🏽 for a pdf of an article released on this study by the author.

Editor’s comment:  

n/a

Conflict of interest/ Funding:  

The authors have no conflict of interest. The study was funded by the Swedish Heart-Lung Foundation, Crafoord Foundation, and Agenda 2030 Graduate School at Lund University.

External relevant links:  

https://eatforum.org/

Corresponding author: 

Anna Stubbendorff

PhD student

Anna.stubbendorff@med.lu.se

Exploring young Australians’ understanding of sustainable and healthy diets: A qualitative study (2022 Jul)

Ronto, R., Saberi, G., Carins, J., Papier, K., & Fox, E. (2022). Exploring young Australians’ understanding of sustainable and healthy diets: A qualitative study. Public Health Nutrition, 1-13. doi:10.1017/S1368980022001513

Open access link to article: 

https://www.cambridge.org/core/journals/public-health-nutrition/article/exploring-young-australians-understanding-of-sustainable-and-healthy-diets-a-qualitative-study/4B88F9E0ED4A61EFF37E10CE6AACA0FE

Relevant to: 

Public health nutrition, sustainability

Question: 

Understanding of and motivators of achieving sustainable and healthy diets among young adults

Bottom line for nutrition practice: 

There is a need for the development and evaluation of individual and micro-environmental-based interventions promote sustainable and healthy diets more comprehensively.

Abstract: 

  • Objective: This qualitative study aimed to explore young Australians’ perspectives, motivators and current practices in achieving a sustainable and healthy diet.
  • Design: Semi-structured online interviews were conducted with young Australians. Interviews were audio-recorded using the online Zoom platform, transcribed and analysed using a deductive analysis method by applying the Theoretical Domains Framework and inductive thematic data analysis.
  • Setting: Young Australians recruited via social media platforms, noticeboard announcements and flyers.
  • Subjects: Twenty-two Australians aged 18 to 25 years.
  • Results: The majority of participants were aware of some aspects of a sustainable and healthy diet and indicated the need to reduce meat intake, increase intake of plant-based foods, reduce food wastage and packaging and reduce food miles. Young adults were motivated to adopt more sustainable dietary practices but reported that individual and environmental factors such as low food literacy, limited food preparation and cooking skills, lack of availability and accessibility of environmentally friendly food options and costs associated with sustainable and healthy diets hindered their ability to do so.
  • Conclusions: Given the barriers faced by many of our participants, there is a need for interventions aimed at improving food literacy and food preparation and cooking skills as well as those that create food environments that make it easy to select sustainable and healthy diets. Future research is needed for longitudinal larger scale quantitative studies to confirm our qualitative findings. In addition, the development and evaluation of individual and micro-environmental-based interventions promote sustainable and healthy diets more comprehensively.

Details of results: 

  • Table 2. Themes, subthemes and illustrative quotes fills two and a half pages of the report with useful insights into the population studied.

Of additional interest: 

n/a

Editor’s comment:  

This is not an audience that has a lot of space within this SFS Toolkit. I hope we can change this and get a lot more adolescent and young adult resources.

Conflict of interest/ Funding:  

Macquarie University New Staff Grant (Grant reference number: PURE 109740183) and the Wellcome Trust, Our Planet Our Health (Livestock, Environment and People – LEAP) (Grant number: 205212/Z/16/Z]

External relevant links:  

n/a

Corresponding author: 

Dr Rimante Ronto
Department of Health Sciences, Macquarie University, Australia
Rimante.ronto@mq.edu.au

Environmentally sustainable hospital foodservices: Drawing on staff perspectives to guide change (2021 January)

Citation: Carino S, Collins J, Malekpour S, Porter J. Environmentally sustainable hospital foodservices: Drawing on staff perspectives to guide change. Sustainable Production and Consumption. 2021/01/01/;25:152-61. https://doi.org/10.1016/j.spc.2020.08.003 (note: there is a paywall to access the full study)

Relevant to: 

Dietitians-Nutritionists working in hospitals or in food services.

Question: 

Forty-six stakeholders working across the hospital supply chain in three Australian hospitals were interviewed regarding their perspectives on: (1) sustainable and unsustainable practices in hospital food provision; (2) barriers and enablers of sustainable practices; and (3) future recommendations for implementing sustainable foodservice practices.

Bottom line for nutrition practice: 

This paper identifies specific sustainable and unsustainable practices across the hospital food chain under the following categories:

  • procurement;
  • food processing (central production kitchen);
  • food service model/ menu design;
  • meal ordering and selection;
  • food preparation;
  • patient consumption;
  • food waste;
  • waste management.

The abstract below summarizes current sustainable and unsustainable practices as well as barriers and enablers to improving sustainability. Future recommendations were generated under 3 themes:

  • (1) practice recommendations;
  • (2) knowledge generation/ sharing recommendations and
  • (3) leadership and policy recommendations. 

The authors emphasize the importance of involving staff in making changes, and suggest that creating best practice guidelines for sustainability within food services could address one of the key barriers identified.

Abstract:

Foodservice is a key contributor to environmental impacts of the healthcare sector, in particular hospitals. Driving towards sustainable solutions in foodservices can bring financial and social benefits, whilst allowing hospitals to position themselves as leaders towards a sustainable food system and healthcare sector. Such a change depends on those working directly or indirectly with foodservices. Staff possess valuable knowledge, ideas, motivation and responsibility for improving the environmental sustainability of the foodservice system.

The aim of this study was to explore the perspectives of staff working across the hospital food supply chain towards: (1) sustainable practices in hospital food provision; (2) existing barriers and enablers; and (3) recommendations for implementing sustainable foodservice practices in the future.

Through qualitative inquiry, semi-structured interviews were conducted with individuals at operational and management levels responsible for policy, purchasing, production, onsite plating and delivery and waste disposal at three hospitals in Australia. Framework analysis was used to synthesise transcribed data into practices, barriers and enablers, and recommendations. Interviews (n=46 participants) identified current sustainable practices including those related to recyclable packaging, effective equipment and technology and efficient processes.

  • Unsustainable practices included restrictions on sourcing food, packaging that cannot be separated or recycled, rigid foodservice models and menu, waste production and processes.
  • Enablers to improve sustainability included the power of individuals to influence change, education on recycling, knowledge generation, audits and grants for innovative research, rebates and quality improvement processes.
  • Barriers included competing priorities, poor communication, lack of training opportunities and knowledge, infection control restrictions, lack of policy, funding, and time between meal ordering and delivery.
  • Participants proposed practice changes across the food supply chain and recommended generation and sharing of knowledge, leadership and policy support.
  • Perspectives of individuals within foodservice reveal shared motivation and desire for sustainable foodservices, with support needed from leaders and policy.
  • Future research should use a co-design approach involving staff to create and implement sustainable strategies within hospitals. To see widespread and timely change, action is needed towards effective and meaningful policy.

Details of results: 

In providing a background to the study, the authors note that the health care supply chain accounts for 71% of health care greenhouse gas emissions, and food is part of the supply chain. In addition to emissions, food also accounts for freshwater and land use, among other environmental impacts, so it is an important consideration for sustainability. The authors stress that examining the way food is managed in hospitals, including studying decisions points at each part of the hospital food supply chain, is important to effectively mitigating environmental impacts. They also suggest that there is a lack of research examining this issue from a systems perspective.

Interviewees included: policy makers; group purchasers; health service managers; central production kitchen staff; food preparation (food services staff, managers and supervisors); nurses; dietitians and waste management staff.

Some specific sustainable practices identified but not listed in the abstract include: “use of water technology to prevent the need for chemical cleaning products”; “use of metal trays”; “electronic menus”; decreasing time between ordering and delivery; “chemical free kitchen”; “patient meal time assistance”; “food waste audit and research”; waste management innovation (p. 155). Other unsustainable practices identified include: lack of organic meat or cage free alternatives; not following standardized recipes; relying on meat and dairy for protein; plastic packaging for individual pre portioned meals; patient difficulty to open items (leading to food waste); food waste technology not provided or working. 

Key barriers and enablers were categorized under several themes. First, under “people and their power and motivation” (p.156), individuals who advocated for change as well as the power of a sustainability team were identified as enablers; it was also noted that patient feedback on food quality enables change, as this is required to meet performance indicators. Second, “competing priorities for action” (p.156) was noted as a barrier, such as infection control requirements which restricted the reuse of unopened, individually pre-packaged foods. Third, while “education training and knowledge generation/ sharing” (p.156) can be an enabler (noting the powerful influence of data), gaps exist (e.g., in orientation training; lack of awareness of best practices). Next, many gaps exist under “policy influence”, including lack of best practice standards. Sustainable procurement can also be difficult as a result of supply contracts. Interviewees also noted that sustainability should be legislated if governments consider it a priority. Finally, foodservice systems can present opportunities (e.g., opening a new kitchen), but gaps were also identified (e.g., food waste resulting from delays between meal ordering and delivery, and as a result of offering a wide range of meal options).

Future recommendations were generated under three themes. First, “practice recommendations” (p. 158) included strategies such as reducing the frequency of meat on the menu and including more plant based options; reducing time between ordering and meal delivery; soliciting patient feedback; reducing food packaging; creating a vegetable garden on site and using generated compost on it. Second “knowledge generation/ sharing recommendations” (p. 158) included recommendations such as the creation of best practice guidelines, increased communication about effective strategies, using business cases to support practices, learning from other institutions, and including sustainability information in orientation sessions. Third, “leadership and policy recommendations” (p. 158) included actions such as funding a sustainability officer and creating a hospital sustainability policy which includes food.

Of additional interest: 

Editor’s comment:  

Interested Dietitians-Nutritionists may want to access the full article, as it identifies many practical actions at various points along the hospital food chain. 

Open access link to article: 

N/A – there is a pay wall to access the article (see citation above)

Conflict of interest/ Funding: 

The authors reported no conflict of interests.   

External relevant links: 

Corresponding author:

Stefanie.carino@monash.edu

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