Adherence to the EAT-Lancet Healthy Reference Diet in Relation to Risk of Cardiovascular Events and Environmental Impact: Results From the EPIC-NL Cohort.

Background The Healthy Reference Diet (HRD) was created to formulate dietary guidelines that would be healthy and sustainable. We aimed to construct a diet score measuring adherence to the HRD and to explore its association with cardiovascular events and environmental impact. Methods and Results We included 35 496 participants from the population-based EPIC-NL (European Prospective Investigation into Cancer and Nutrition-Netherlands) study. HRD scores were calculated using data from food frequency questionnaires (0-140). Data on morbidity and mortality were retrieved through linkage with national and death registries. Data on environmental impact indicators were obtained from life cycle assessments. Associations between adherence to the HRD and cardiovascular events were estimated with Cox proportional hazard models. Linear regression analysis was conducted for the adherence to the HRD and each environmental indicator. High adherence to the HRD was associated with 14%, 12%, and 11% lower risks of cardiovascular disease (hazard ratio [HR]Q4vsQ1, 0.86 [95% CI, 0.78-0.94]), coronary heart disease (HRQ4vsQ1, 0.88 [95% CI, 0.78-1.00]), and total stroke (HRQ4vsQ1, 0.89 [95% CI, 0.72-1.10]), respectively. High HRD adherence was associated with 2.4% (95% CI, -5.0 to 0.2) lower greenhouse gas emissions, 3.9% (95% CI, -5.2 to -2.6) less land use, 0.5% (95% CI, -2.6 to 1.6), less freshwater eutrophication, 3.3% (95% CI, -5.8 to -0.8), less marine eutrophication, 7.7% (95% CI, -10.8 to -4.6), less terrestrial acidification, and 32.1 % (95% CI, 28.5-35.7) higher blue water use. Conclusions High adherence to the HRD was associated with lower risk of cardiovascular disease, coronary heart disease, and modestly lower levels of most environmental indicators but a higher level of blue water use.

Evaluation of foods, drinks and diets in the Netherlands according to the degree of processing for nutritional quality, environmental impact and food costs.

OBJECTIVE: This study investigates nutritional quality, environmental impact and costs of foods and drinks and their consumption in daily diets according to the degree of processing across the Dutch population. DESIGN: The NOVA classification was used to classify the degree of processing (ultra-processed foods (UPF) and ultra-processed drinks (UPD)). Food consumption data were derived from the Dutch National Food Consumption Survey 2012-2016. Indicators assessed were nutritional quality (saturated fatty acids (SFA), sodium, mono and disaccharides (sugar), fibre and protein), environmental impact (greenhouse gas (GHG) emissions and blue water use) and food costs. SETTING: The Netherlands. PARTICIPANTS: Four thousand three hundred thirteen Dutch participants aged 1 to 79 years. RESULTS: Per 100 g, UPF were more energy-dense and less healthy than unprocessed or minimally processed foods (MPF); UPF were associated with higher GHG emissions and lower blue water use, and were cheaper. The energy and sugar content of UPD were similar to those of unprocessed or minimally processed drinks (MPD); associated with similar GHG emissions but blue water use was less, and they were also more expensive. In the average Dutch diet, per 2000 kcal, ultra-processed foods and drinks (UPFD) covered 29% (456 g UPF and 437 g UPD) of daily consumption and 61% of energy intake. UPFD consumption was higher among children than adults, especially for UPD. UPFD consumption determined 45% of GHG emissions, 23% of blue water use and 39% of expenses for daily food consumption. UPFD consumption contributed 54% to 72% to daily sodium, sugar and SFA intake. CONCLUSIONS: Compared with unprocessed or minimally processed foods and drinks, UPF and UPD were found to be less healthy considering their high energy, SFA, sugar and sodium content. However, UPF were associated higher GHG emissions and with less blue water use and food costs. Therefore daily blue water use and food costs might increase if UPF are replaced by those unprocessed or minimally processed. As nutritional quality, environmental impacts and food costs relate differently to the NOVA classification, the classification is not directly applicable to identify win-win-wins of nutritional quality, environmental impact and costs of diets.

Exploring culturally acceptable, nutritious, affordable and low climatic impact diet for Japanese diets: proof of concept of applying a new modelling approach using data envelopment analysis.

A future sustainable dietary pattern for Japanese is yet undefined. This study aimed to explore more sustainable Japanese diets that are nutritious, affordable and with low greenhouse gas emissions (GHGE) and particular emphasis on cultural acceptability. A newly developed data envelopment analysis (DEA) diet model was applied to 4-d dietary record data among 184 healthy Japanese men and 185 women volunteers aged 21-69 years. Alternative diets were calculated as the linear combinations of observed diets. Firstly, for each individual, four modelled diets were calculated that maximised cultural acceptability (i.e. minimise dietary change from observed diet), maximised nutritional quality assessed by the Nutrient-Rich Food Index (NRF), minimised monetary diet costs or minimised diet-related GHGE. The final modelled diet combined all four indicators. In the first four models, the largest improvement was obtained for each targeted indicator separately, while relatively small improvements or unwanted changes were observed for other indicator. When all indicators were aimed to optimise, the NRF score and diet-related GHGE were improved by 8-13 % with the lower monetary cost than observed diets, although the percentage improvement was a bit smaller than the separate models. The final modelled diets demanded increased intakes for whole grains, fruits, milk/cream/yogurt, legumes/nuts, and decreased intakes for red and processed meat, sugar/confectioneries, alcoholic and sweetened beverages, and seasonings in both sexes. In conclusion, more sustainable dietary patterns considering several indicators are possible for Japanese, while total improvement is moderate due to trade-offs between indicators and methodological limitation of DEA diet model.

Evaluation of Nutri-Score in Relation to Dietary Guidelines and Food Reformulation in The Netherlands.

An unhealthy dietary pattern is an important risk factor for non-communicable diseases. Front-of-Pack nutritional labels such as Nutri-Score can be used to improve food choices. In addition, products can be improved through reformulation. The current study investigates to what extent Nutri-Score aligns with the Dutch Health Council dietary guidelines and whether it can be used as an incentive for reformulation. Nutri-Score calculations were based on the Dutch Branded Food database (2018). The potential shift in Nutri-Score was calculated with product improvement scenarios. The Nutri-Score classification is in line with these dietary guidelines: increase the consumption of fruit and vegetables, pulses, and unsalted nuts. It is, however, less in line with the recommendations to limit (dairy) drinks with added sugar, reduce the consumption of red meat and replace refined cereal products with whole-grain products. The scenario analyses indicated that a reduction in sodium, saturated fat or sugars resulted in a more favourable Nutri-Score in a large variety of food groups. However, the percentage of products with an improved Nutri-Score varied greatly between the different food groups. Alterations to the algorithm may strengthen Nutri-Score in order to help consumers with their food choices.

Co-benefits from sustainable dietary shifts for population and environmental health: an assessment from a large European cohort study.

BACKGROUND: Unhealthy diets, the rise of non-communicable diseases, and the declining health of the planet are highly intertwined, where food production and consumption are major drivers of increases in greenhouse gas emissions, substantial land use, and adverse health such as cancer and mortality. To assess the potential co-benefits from shifting to more sustainable diets, we aimed to investigate the associations of dietary greenhouse gas emissions and land use with all-cause and cause-specific mortality and cancer incidence rates. METHODS: Using data from 443 991 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a multicentre prospective cohort, we estimated associations between dietary contributions to greenhouse gas emissions and land use and all-cause and cause-specific mortality and incident cancers using Cox proportional hazards regression models. The main exposures were modelled as quartiles. Co-benefits, encompassing the potential effects of alternative diets on all-cause mortality and cancer and potential reductions in greenhouse gas emissions and land use, were estimated with counterfactual attributable fraction intervention models, simulating potential effects of dietary shifts based on the EAT-Lancet reference diet. FINDINGS: In the pooled analysis, there was an association between levels of dietary greenhouse gas emissions and all-cause mortality (adjusted hazard ratio [HR] 1·13 [95% CI 1·10-1·16]) and between land use and all-cause mortality (1·18 [1·15-1·21]) when comparing the fourth quartile to the first quartile. Similar associations were observed for cause-specific mortality. Associations were also observed between all-cause cancer incidence rates and greenhouse gas emissions, when comparing the fourth quartile to the first quartile (adjusted HR 1·11 [95% CI 1·09-1·14]) and between all-cause cancer incidence rates and land use (1·13 [1·10-1·15]); however, estimates differed by cancer type. Through counterfactual attributable fraction modelling of shifts in levels of adherence to the EAT-Lancet diet, we estimated that up to 19-63% of deaths and up to 10-39% of cancers could be prevented, in a 20-year risk period, by different levels of adherence to the EAT-Lancet reference diet. Additionally, switching from lower adherence to the EAT-Lancet reference diet to higher adherence could potentially reduce food-associated greenhouse gas emissions up to 50% and land use up to 62%. INTERPRETATION: Our results indicate that shifts towards universally sustainable diets could lead to co-benefits, such as minimising diet-related greenhouse gas emissions and land use, reducing the environmental footprint, aiding in climate change mitigation, and improving population health. FUNDING: European Commission (DG-SANCO), the International Agency for Research on Cancer (IARC), MRC Early Career Fellowship (MR/M501669/1).

Can Healthy and Sustainable Dietary Patterns That Fit within Current Dutch Food Habits Be Identified?

This study investigated major healthy and sustainable dietary patterns in the Dutch population. Two 24-hour dietary recalls were collected in 2078 participants aged 19-79 years in the Dutch National Food Consumption Survey 2012-2016. Dietary patterns were identified using reduced rank regression. Predictor variables were food groups and response variables were Dutch Healthy Diet index 2015 (DHD15-index) score, greenhouse gas emissions (GHGE), and blue water use. Three patterns were discovered, including a "high fruit and vegetable dietary pattern", a "low meat dietary pattern", and a "high dairy, low fruit juices dietary pattern". Diets in the highest quartile of these patterns had higher DHD15-index score than the average population. However, diets of the "high fruit and vegetable dietary pattern" were associated with higher dietary GHGE (14%) and blue water use (69.2%) compared to the average population. Diets of the "low meat dietary pattern" were associated with lower GHGE (19.6%) and higher blue water use (7.7%). Concluding, the "low meat dietary pattern" was the most healthy and sustainable dietary pattern in this population. The addition of blue water use as an environmental impact indicator shows the difficulty of finding existing dietary patterns that have low environmental impact in all determinants.

A social cost-benefit analysis of meat taxation and a fruit and vegetables subsidy for a healthy and sustainable food consumption in the Netherlands.

BACKGROUND: Implementation of food taxes or subsidies may promote healthier and a more sustainable diet in a society. This study estimates the effects of a tax (15% or 30%) on meat and a subsidy (10%) on fruit and vegetables (F&V) consumption in the Netherlands using a social cost-benefit analysis with a 30-year time horizon. METHODS: Calculations with the representative Dutch National Food Consumption Survey (2012-2014) served as the reference. Price elasticities were applied to calculate changes in consumption and consumer surplus. Future food consumption and health effects were estimated using the DYNAMO-HIA model and environmental impacts were estimated using Life Cycle Analysis. The time horizon of all calculations is 30 year. All effects were monetarized and discounted to 2018 euros. RESULTS: Over 30-years, a 15% or 30% meat tax or 10% F&V subsidy could result in reduced healthcare costs, increased quality of life, and higher productivity levels. Benefits to the environment of a meat tax are an estimated €3400 million or €6300 million in the 15% or 30% scenario respectively, whereas the increased F&V consumption could result in €100 million costs for the environment. While consumers benefit from a subsidy, a consumer surplus of €10,000 million, the tax scenarios demonstrate large experienced costs of respectively €21,000 and €41,000 million. Overall, a 15% or 30% price increase in meat could lead to a net benefit for society between €3100-7400 million or €4100-12,300 million over 30 years respectively. A 10% F&V subsidy could lead to a net benefit to society of €1800-3300 million. Sensitivity analyses did not change the main findings. CONCLUSIONS: The studied meat taxes and F&V subsidy showed net total welfare benefits for the Dutch society over a 30-year time horizon.

Healthy diets with reduced environmental impact? - The greenhouse gas emissions of various diets adhering to the Dutch food based dietary guidelines.

OBJECTIVE: To determine the differences in environmental impact and nutrient content of the current Dutch diet and four healthy diets aimed at lowering greenhouse gas (GHG) emissions. METHODS: GHG emissions (as proxy for environmental impact) and nutrient content of the current Dutch diet and four diets adhering to the Dutch food based dietary guidelines (Wheel of Five), were compared in a scenario study. Scenarios included a healthy diet with or without meat, and the same diets in which only foods with relatively low GHG emissions are chosen. For the current diet, data from the Dutch National Food Consumption Survey 2007-2010 were used. GHG emissions (in kg CO2-equivalents) were based on life cycle assessments. Results are reported for men and women aged 19-30years and 31-50years. RESULTS: The effect on GHG emissions of changing the current Dutch diet to a diet according to the Wheel of Five (corresponding with the current diet as close as possible), ranged from -13% for men aged 31-50years to +5% for women aged 19-30years. Replacing meat in this diet and/or consuming only foods with relatively low GHG emissions resulted in average GHG emission reductions varying from 28-46%. In the scenarios in which only foods with relatively low GHG emissions are consumed, fewer dietary reference intakes (DRIs) were met than in the other healthy diet scenarios. However, in all healthy diet scenarios the number of DRIs being met was equal to or higher than that in the current diet. CONCLUSIONS: Diets adhering to food based dietary guidelines did not substantially reduce GHG emissions compared to the current Dutch diet, when these diets stayed as close to the current diet as possible. Omitting meat from these healthy diets or consuming only foods with relatively low associated GHG emissions both resulted in GHG emission reductions of around a third. These findings may be used to expand food based dietary guidelines with information on how to reduce the environmental impact of healthy diets.

Reducing GHG emissions while improving diet quality: exploring the potential of reduced meat, cheese and alcoholic and soft drinks consumption at specific moments during the day.

BACKGROUND: The typical Western diet is associated with high levels of greenhouse gas (GHG) emissions and with obesity and other diet-related diseases. This study aims to determine the impact of adjustments to the current diet at specific moments of food consumption, to lower GHG emissions and improve diet quality. METHODS: Food consumption in the Netherlands was assessed by two non-consecutive 24-h recalls for adults aged 19-69 years (n = 2102). GHG emission of food consumption was evaluated with the use of life cycle assessments. The population was stratified by gender and according to tertiles of dietary GHG emission. Scenarios were developed to lower GHG emissions of people in the highest tertile of dietary GHG emission; 1) reducing red and processed meat consumed during dinner by 50% and 75%, 2) replacing 50% and 100% of alcoholic and soft drinks (including fruit and vegetable juice and mineral water) by tap water, 3) replacing cheese consumed in between meals by plant-based alternatives and 4) two combinations of these scenarios. Effects on GHG emission as well as nutrient content of the diet were assessed. RESULTS: The mean habitual daily dietary GHG emission in the highest tertile of dietary GHG emission was 6.7 kg CO2-equivalents for men and 5.1 kg CO2-equivalents for women. The scenarios with reduced meat consumption and/or replacement of all alcoholic and soft drinks were most successful in reducing dietary GHG emissions (ranging from - 15% to - 34%) and also reduced saturated fatty acid intake and/or sugar intake. Both types of scenarios lead to reduced energy and iron intakes. Protein intake remained adequate. CONCLUSIONS: Reducing the consumption of red and processed meat during dinner and of soft and alcoholic drinks throughout the day leads to significantly lower dietary GHG emissions of people in the Netherlands in the highest tertile of dietary GHG emissions, while also having health benefits. For subgroups of the population not meeting energy or iron requirements as a result of these dietary changes, low GHG emission and nutritious replacement foods might be needed in order to meet energy and iron requirements.

Does a better adherence to dietary guidelines reduce mortality risk and environmental impact in the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition?

Guidelines for a healthy diet aim to decrease the risk of chronic diseases. It is unclear as to what extent a healthy diet is also an environmentally friendly diet. In the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition, the diet was assessed with a 178-item FFQ of 40 011 participants aged 20-70 years between 1993 and 1997. The WHO's Healthy Diet Indicator (HDI), the Dietary Approaches to Stop Hypertension (DASH) score and the Dutch Healthy Diet index 2015 (DHD15-index) were investigated in relation to greenhouse gas (GHG) emissions, land use and all-cause mortality risk. GHG emissions were associated with HDI scores (-3·7 % per sd increase (95 % CI -3·4, -4·0) for men and -1·9 % (95 % CI -0·4, -3·4) for women), with DASH scores in women only (1·1 % per sd increase, 95 % CI 0·9, 1·3) and with DHD15-index scores (-2·5 % per sd increase (95 % CI -2·2, -2·8) for men and -2·0 % (95 % CI -1·9, -2·2) for women). For all indices, higher scores were associated with less land use (ranging from -1·3 to -3·1 %). Mortality risk decreased with increasing scores for all indices. Per sd increase of the indices, hazard ratios for mortality ranged from 0·88 (95 % CI 0·82, 0·95) to 0·96 (95 % CI 0·92, 0·99). Our results showed that adhering to the WHO and Dutch dietary guidelines will lower the risk of all-cause mortality and moderately lower the environmental impact. The DASH diet was associated with lower mortality and land use, but because of high dairy product consumption in the Netherlands it was also associated with higher GHG emissions.

Salt Reductions in Some Foods in The Netherlands: Monitoring of Food Composition and Salt Intake.

BACKGROUND AND OBJECTIVES: High salt intake increases blood pressure and thereby the risk of chronic diseases. Food reformulation (or food product improvement) may lower the dietary intake of salt. This study describes the changes in salt contents of foods in the Dutch market over a five-year period (2011-2016) and differences in estimated salt intake over a 10-year period (2006-2015). METHODS: To assess the salt contents of foods; we obtained recent data from chemical analyses and from food labels. Salt content of these foods in 2016 was compared to salt contents in the 2011 version Dutch Food Composition Database (NEVO, version 2011), and statistically tested with General Linear Models. To estimate the daily dietary salt intake in 2006, 2010, and 2015, men and women aged 19 to 70 years were recruited through random population sampling in Doetinchem, a small town located in a rural area in the eastern part of the Netherlands. The characteristics of the study population were in 2006: n = 317, mean age 49 years, 43% men, in 2010: n = 342, mean age 46 years, 45% men, and in 2015: n = 289, mean age 46 years, 47% men. Sodium and potassium excretion was measured in a single 24-h urine sample. All estimates were converted to a common metric: salt intake in grams per day by multiplication of sodium with a factor of 2.54. RESULTS: In 2016 compared to 2011, the salt content in certain types of bread was on average 19 percent lower and certain types of sauce, soup, canned vegetables and legumes, and crisps had a 12 to 26 percent lower salt content. Salt content in other types of foods had not changed significantly. Between 2006, 2010 and 2015 the estimated salt intake among adults in Doetinchem remained unchanged. In 2015, the median estimated salt intake was 9.7 g per day for men and 7.4 g per day for women. As in 2006 and 2010, the estimated salt intake in 2015 exceeded the recommended maximum intake of 6 g per day set by the Dutch Health Council. CONCLUSION: In the Netherlands, the salt content of bread, certain sauces, soups, potato crisps, and processed legumes and vegetables have been reduced over the period 2011-2016. However, median salt intake in 2006 and 2015 remained well above the recommended intake of 6 g.

How may a shift towards a more sustainable food consumption pattern affect nutrient intakes of Dutch children?

OBJECTIVE: Food has a considerable environmental impact. Diets with less meat and dairy reduce environmental impact but may pose nutritional challenges for children. The current modelling study investigates the impact of diets with less or no meat and dairy products on nutrient intakes. DESIGN: Energy and nutrient intakes were assessed for observed consumption patterns (reference) and two replacement scenarios with data from the Dutch National Food Consumption Survey - Young Children (2005-2006). In the replacement scenarios, 30 % or 100 % of the consumed dairy and meat (in grams) was replaced by plant-derived foods with similar use. SETTING: The Netherlands. SUBJECTS: Children (n 1279) aged 2-6 years. RESULTS: Partial and full replacement of meat and dairy foods by plant-derived foods reduced SFA intake by 9 % and 26 %, respectively, while fibre intake was 8 % and 29 % higher. With partial replacement, micronutrient intakes were similar, except for lower vitamin B12 intake. After full meat and dairy replacement, mean intakes of Ca, Zn and thiamin decreased by 5-13 %, and vitamin B12 intake by 49 %, while total intake of Fe was higher but of lower bioavailability. With full replacement, the proportion of girls aged 4-6 years with intakes below recommendations was 15 % for thiamin, 10 % for vitamin B12 and 6 % for Zn. CONCLUSIONS: Partial replacement of meat and dairy by plant-derived foods is beneficial for children's health by lowering SFA intake, increasing fibre content and maintaining similar micronutrient intakes. When full replacements are made, attention is recommended to ensure adequate thiamin, vitamin B12 and Zn intakes.

Reduced-Sodium Lunches Are Well-Accepted by Uninformed Consumers Over a 3-Week Period and Result in Decreased Daily Dietary Sodium Intakes: A Randomized Controlled Trial.

BACKGROUND: Processed foods are major contributors to excessive sodium intake in Western populations. We investigated the effect of food reformulation on daily dietary sodium intake. OBJECTIVE: To determine whether uninformed consumers accept reduced-sodium lunches and to determine the effect of consuming reduced-sodium lunches on 24-hour urinary sodium excretion. DESIGN: A single-blind randomized controlled pretest-posttest design with two parallel treatment groups was used. PARTICIPANTS/SETTING: Participants chose foods in an experimental real-life canteen setting at the Restaurant of the Future in Wageningen, the Netherlands, from May 16 until July 1, 2011. INTERVENTION: After a run-in period with regular foods for both groups, the intervention group (n=36) consumed foods with 29% to 61% sodium reduction (some were partially flavor compensated). The control group (n=38) continued consuming regular foods. MAIN OUTCOME MEASURES: Outcomes for assessment of acceptance were the amount of foods consumed, energy and sodium intake, remembered food liking, and intensity of sensory aspects. Influence on daily dietary sodium intake was assessed by 24-hour urinary sodium excretion. STATISTICAL ANALYSES PERFORMED: Between and within-subject comparisons were assessed by analysis of covariance. RESULTS: Energy intake and amount consumed of each food category per lunch remained similar for both groups. Compared with the control group, the intervention group's sodium intake per lunch was significantly reduced by -1,093 mg (adjusted difference) (95% CI -1,285 to -901), equivalent to 43 mmol sodium. Remembered food liking, taste intensity, and saltiness were scored similarly for almost all of the reduced-sodium foods compared with the regular foods. After consuming reduced-sodium lunches, compared with the control group, intervention participants' 24-hour urinary sodium excretion was significantly lower by -40 mEq (adjusted difference) (95% CI -63 to -16) than after consuming regular lunches, and this reflects a decreased daily sodium intake of 1 g. CONCLUSIONS: Comparing the two treatment groups, consumption of reduced-sodium foods over a 3-week period was well accepted by the uninformed participants in an experimental real-life canteen setting. The reduced-sodium foods did not trigger compensation behavior during the remainder of the day in the intervention group compared with the control group, as reflected by 24-hour urinary sodium excretion. Therefore, offering reduced-sodium foods without explicitly informing consumers of the sodium reduction can contribute to daily sodium intake reduction.

Greenhouse gas emission of diets in the Netherlands and associations with food, energy and macronutrient intakes.

OBJECTIVE: To evaluate the greenhouse gas emission (GHGE) of diets in Dutch girls, boys, women and men and to explore associations with diet composition. DESIGN: Descriptive analyses for the total population as well as stratified for gender, age and dietary environmental load. SETTING: The Netherlands. SUBJECTS: Dutch children and adults aged 7-69 years (n 3818). RESULTS: The GHGE of daily diets was on average 3·2 kg CO2-equivalents (CO2e) for girls, 3·6 kg CO2e for boys, 3·7 kg CO2e for women and 4·8 kg CO2e for men. Meat and cheese contributed about 40 % and drinks (including milk and alcoholic drinks) 20 % to daily GHGE. Considerable differences in environmental loads of diets existed within age and gender groups. Persons with higher-GHGE diets consumed more (in quantity of foods and especially drinks) than their counterparts of a similar sex and age with low-GHGE diets. Major differences between high- and low-GHGE diets were in meat, cheese and dairy consumption as well as in soft drinks (girls, boys and women) and alcoholic drinks (men). Of those, differences in meat consumption determined the differences in GHGE most. Diets with higher GHGE were associated with higher saturated fat intake and lower fibre intake CONCLUSIONS: GHGE of daily diets in the Netherlands is between 3 and 5 kg CO2e, with considerable differences between individuals. Meat, dairy and drinks contribute most to GHGE. The insights of the study may be used in developing (age- and gender-specific) food-based dietary guidelines that take into account both health and sustainability aspects.

Reducing our environmental footprint and improving our health: greenhouse gas emission and land use of usual diet and mortality in EPIC-NL: a prospective cohort study.

BACKGROUND: Food choices influence health status, but also have a great impact on the environment. The production of animal-derived foods has a high environmental burden, whereas the burden of refined carbohydrates, vegetables and fruit is low. The aim of this study was to investigate the associations of greenhouse gas emission (GHGE) and land use of usual diet with mortality risk, and to estimate the effect of a modelled meat substitution scenario on health and the environment. METHODS: The usual diet of 40011 subjects in the EPIC-NL cohort was assessed using a food frequency questionnaire. GHGE and land use of food products were based on life cycle analysis. Cox proportional hazard ratios (HR) were calculated to determine relative mortality risk. In the modelled meat-substitution scenario, one-third (35 gram) of the usual daily meat intake (105 gram) was substituted by other foods. RESULTS: During a follow-up of 15.9 years, 2563 deaths were registered. GHGE and land use of the usual diet were not associated with all-cause or with cause-specific mortality. Highest vs. lowest quartile of GHGE and land use adjusted hazard ratios for all-cause mortality were respectively 1.00 (95% CI: 0.86-1.17) and 1.05 (95% CI: 0.89-1.23). Modelled substitution of 35 g/d of meat with vegetables, fruit-nuts-seeds, pasta-rice-couscous, or fish significantly increased survival rates (6-19%), reduced GHGE (4-11%), and land use (10-12%). CONCLUSIONS: There were no significant associations observed between dietary-derived GHGE and land use and mortality in this Dutch cohort. However, the scenario-study showed that substitution of meat with other major food groups was associated with a lower mortality risk and a reduced environmental burden. Especially when vegetables, fruit-nuts-seeds, fish, or pasta-rice-couscous replaced meat.

Replacement of meat and dairy by plant-derived foods: estimated effects on land use, iron and SFA intakes in young Dutch adult females.

OBJECTIVE: Reduction in the current high levels of meat and dairy consumption may contribute to environmental as well as human health. Since meat is a major source of Fe, effects on Fe intake need to be evaluated, especially in groups vulnerable to negative Fe status. In the present study we evaluated the effects of replacing meat and dairy foods with plant-based products on environmental sustainability (land requirement) and health (SFA and Fe intakes) in women. DESIGN: Data on land requirements were derived from existing calculation methods. Food composition data were derived from the Dutch Food Composition Table 2006. Data were linked to the food consumption of young Dutch women. Land requirements and nutrient intakes were evaluated at baseline and in two scenarios in which 30% (Scenario_30%) or 100% (Scenario_100%) of the dairy and meat consumption was randomly replaced by the same amount of plant-based dairy- and meat-replacing foods. SETTING: The Netherlands. SUBJECTS: Three hundred and ninety-eight young Dutch females. RESULTS: Replacement of meat and dairy by plant-based foods benefited the environment by decreasing land use. The intake of SFA decreased considerably compared with the baseline situation. On average, total Fe intake increased by 2.5 mg/d, although most of the Fe intake was from a less bioavailable source. CONCLUSIONS: Replacement of meat and dairy foods by plant-based foods reduced land use for consumption and SFA intake of young Dutch females and did not compromise total Fe intake.

A salt reduction of 50% in bread does not decrease bread consumption or increase sodium intake by the choice of sandwich fillings.

Bread is a major contributor to sodium intake in many countries. Reducing the salt (NaCl) content in bread might be an effective way to reduce overall sodium intake. The objectives of this study were to examine the effects of gradually lowering the salt content in brown bread, with and without flavor compensation (KCl and yeast extract), on bread consumption and sodium intake compensation by choice of sandwich fillings. A total of 116 participants (age: 21 ± 3 y; BMI: 22 ± 2 kg/m²) consumed a buffet-style breakfast on weekdays for 4 wk. Participants received either regular bread (control group: n = 39), bread whose salt content was gradually lowered each week by 0, 31, 52, and 67% (reduced group: n = 38), or bread whose salt content was also gradually lowered each week but which was also flavor compensated (compensated group: n = 39). A reduction of up to 52% of salt in bread did not lead to lower consumption of bread compared to the control (P = 0.57), whereas less bread was consumed when salt was reduced by 67% (P = 0.006). When bread was flavor compensated, however, a reduction of 67% did not lead to lower consumption (P = 0.69). Salt reduction in bread (with and without flavor compensation) did not induce sodium intake compensation (P = 0.31). In conclusion, a salt reduction of up to 52% in bread or even up to 67% in flavor-compensated bread neither affected bread consumption nor choice of sandwich fillings.

Impact of foods with health logo on saturated fat, sodium and sugar intake of young Dutch adults.

OBJECTIVE: Health logos are introduced to distinguish foods with 'healthier' nutrient composition from regular foods. In the present study, we evaluated the effects of changed food compositions according to health logo criteria on the intake of saturated fat, sugar and sodium in a Dutch population of young adults. DESIGN: Foods in the Dutch food composition table were evaluated against nutrient criteria for logo eligibility. Three replacement scenarios were compared with the nutrient intake 'as measured' in the Dutch consumption survey. The foods not complying with health logo criteria were replaced either by 'virtual' foods exactly complying with the health logo criteria, with real 2007 market shares (scenario I) and 100% market shares (scenario II), or by existing similar foods with a composition that already complied with the health logo criteria (scenario III). RESULTS: The percentage reduction in nutrient intake with the current 2007 market shares of 'health logo foods' was -2.5% for SFA, 0% for sodium and -1% for sugar. With a 100% market share these reductions would be -10% for SFA, -4% for sodium and -6% for sugar. This may lead to a reduction of -40% for SFA, -23% for sodium and -36% for sugar in the most optimal replacement scenario. CONCLUSIONS: With 'health logo foods', available in 2007 and current consumption patterns, small reductions can be achieved for SFA and sugar. For additional reductions, lowering the fat/sodium content of meat (products) towards health logo criteria and drinks without sugar towards limits far below health logo criteria would be the most effective reformulation strategy.

Impact of fatty acid food reformulations on intake of Dutch young adults.

BACKGROUND: The Dutch'Task Force for the Improvement of the Fatty Acid Composition' initiated fatty acid reformulations in branches using vegetable oils and fats to reduce the trans (TFA) and saturated fatty acid (SFA) content of foods. OBJECTIVE: This study estimates the impact of recent reformulations in the task force food groups by estimating changes in median intake of TFA and SFA in Dutch young adults. METHODS: This is a modelling study with food consumption data of young adults. Intakes were estimated before reformulation using food composition data of 2001 as a reference and while including most recent fatty acid composition of foods for task force food groups. Food composition of other foods and food consumption was assumed unchanged. RESULTS: Average TFA intake significantly decreased from 1.0 E% in the reference to 0.8 E% in the reformulation scenario. Pastry, cakes and biscuits, and snacks contributed most to the decrease of TFA. Estimated SFA intake did not change. When solid baking and spreading fats were additionally replaced with fluid ones, SFA intake decreases from 12.9 E% to 12.1 E%. CONCLUSION: Fatty acid reformulation in the task force food groups contributed to reductions in TFA intake. For further reductions in SFA intake a different food choice is primordial.