Mapping the evidence of novel plant-based foods: a systematic review of nutritional, health, and environmental impacts in high-income countries.

CONTEXT: Shifting from current dietary patterns to diets rich in plant-based (PB) foods and lower in animal-based foods (ABFs) is generally regarded as a suitable strategy to improve nutritional health and reduce environmental impacts. Despite the recent growth in supply of and demand for novel plant-based foods (NPBFs), a comprehensive overview is lacking. OBJECTIVES: This review provides a synthesis of available evidence, highlights challenges, and informs public health and environmental strategies for purposeful political decision-making by systematically searching, analyzing, and summarizing the available literature. DATA SOURCES: Five peer-reviewed databases and grey literature sources were rigorously searched for publications. DATA EXTRACTION: Study characteristics meeting the inclusion criteria regarding NPBF nutrient composition and health and environmental outcomes in high-income countries were extracted. DATA ANALYSIS: Fifty-seven peer-reviewed and 36 grey literature sources were identified; these were published in 2016-2022. NPBFs typically have substantially lower environmental impacts than ABFs, but the nutritional contents are complex and vary considerably across brands, product type, and main primary ingredient. In the limited evidence on the health impacts, shifts from ABFs to PB meats were associated with positive health outcomes. However, results were mixed for PB drinks, with links to micronutrient deficiencies. CONCLUSION: If carefully selected, certain NPBFs have the potential to be healthier and nutrient-rich alternatives to ABFs and typically have smaller environmental footprints. More disaggregated categorization of various types of NPBFs would be a helpful step in guiding consumers and key stakeholders to make informed decisions. To enable informed policymaking on the inclusion of NPBFs in dietary transitions as part of a wider net-zero and health strategy, future priorities should include nutritional food standards, labelling, and subdivisions or categorizations of NPBFs, as well as short- and long-term health studies evaluating dietary shifts from ABFs to NPBFs and standardized environmental impact assessments, ideally from independent funders.

The role of plant-based alternative foods in sustainable and healthy food systems: Consumption trends in the UK.

A global transformation towards sustainable food systems is crucial for delivering on climate change mitigation targets worldwide. In high- and middle-income settings, plant-based meat and dairy alternatives present potential substitutes for animal sourced foods, and a pathway to transition to more sustainable diets. We examined plant-based alternative foods (PBAF) consumption trends in the UK by analysing repeated cross-sectional food consumption data from the National Diet and Nutrition Survey 2008-2019. Dietary data for 15,655 individuals aged 1.5 years and over were analysed to assess aggregate change in intake of PBAF and six other food groups that play a role in transformative dietary change. Characteristics associated with consumption of PBAF were explored using logistic regression, and consumption patterns in high and low meat consumers were explored by examining intake of potential animal product substitute food groups. The proportion of individuals reporting consumption of any PBAFs increased from 6.7% in 2008-2011, to 13.1% in 2017-2019 (p < 0.01). Compared to 2008-2011 PBAF consumption rose by 115% in 2017-2019 (p < 0.01). Females were 46% more likely than males to report consumption of PBAF (p < 0.01). Millennials (age 24-39 years) were the most likely generation to report PBAF consumption (p < 0.01 compared to generation Z (age 11-23 years) and traditionalists (age 75+ years)), as were individuals of the highest income tertile (p < 0.01). Among "low meat consumers", PBAF consumption was on average higher than "high meat consumers" (18.6 g versus 4.8 g PBAF per day, p < 0.01). Our results support the hypothesis of a pivotal role of PBAF in the transition towards sustainable food systems in the UK, by demonstrating they are becoming increasingly popular among UK consumers. This highlights the urgent need to assess in detail the environmental and health impacts of large scale and population-wide consumption of PBAF in comparison to their animal-based equivalents.

The association of dimensions of fruit and vegetable access in the retail food environment with consumption; a systematic review.

The consumption of fruit and vegetables (F&V) is important for human health to protect against non-communicable disease and micronutrient deficiency. Increasing consumption of F&V may also benefit planetary health if these foods are substituted for foods with higher environmental footprints such as red meat or dairy. The retail food environment (RFE) is an influential junction between the food system and individual diets as it drives access to F&V through external (physical access) and personal (availability, affordability, acceptability) domains. We performed a systematic search of six literature databases (January 2021) for studies assessing access to F&V in the RFE and its association with F&V consumption in adults in high- and upper-middle income countries. 36 studies were identified and categorised by dimensions of food access - accessibility, affordability, acceptability, availability and accommodation. More than half of the studies (n = 20) were based in the USA. F&V accessibility was the most commonly reported dimension (n = 29); no study reported on accommodation. 6 studies were rated to be high quality. A positive association of increased availability of F&V options in the RFE with intake was identified in 9 of 15 studies. Associations in both acceptability and accessibility dimensions were inconsistent. No association was observed between F&V affordability and consumption although available data were limited. Many challenges exist to building a robust evidence base within food environment research including conceptual, definitional and methodological heterogeneity and measurement standardisation. Future food policies should consider multi-dimensional interventions to promote access to F&V in the RFE across all domains.

UK's fruit and vegetable supply increasingly dependent on imports from climate vulnerable producing countries.

Domestic contribution to total fruit and vegetable supply in the UK decreased from 42% in 1987 to 22% in 2013. The impact of this changing pattern of UK fruit and vegetable imports, from countries with different vulnerabilities to projected climate change, on the resilience of the UK food system is currently unknown. Here, we used the UN FAO bilateral trade database over a period of 27 years to estimate changes in fruit and vegetable supply in the UK, and the NDGAIN climate vulnerability categories to assess the climate vulnerability of countries supplying fruit and vegetables to the UK. The diversity of fruit and vegetable supply has increased from 21 crops, comprising the top 80% of all fruit and vegetables supplied to the UK in 1987, to 34 crops in 2013. The contribution of tropical fruits has rapidly increased while that of more traditional vegetables, such as cabbages and carrots, has declined. The proportion of fruit and vegetables supplied to the UK market from climate vulnerable countries increased from 20% in 1987 to 32% in 2013. Sensitivity analyses - using climatic and freshwater availability indicators - supported these findings. Increased reliance on fruit and vegetable imports from climate vulnerable countries could negatively affect the availability, price and consumption of fruit and vegetables in the UK, affecting dietary intake and health particularly of older people and low-income households. Inter-sectoral actions across agriculture, health, environment, and trade are critical in both the UK and countries that export to the UK to increase the resilience of the food system, and support population health.

Health impacts and environmental footprints of diets that meet the Eatwell Guide recommendations: analyses of multiple UK studies.

OBJECTIVES: To assess the health impacts and environmental consequences of adherence to national dietary recommendations (the Eatwell Guide (EWG)) in the UK. DESIGN AND SETTING: A secondary analysis of multiple observational studies in the UK. PARTICIPANTS: Adults from the European Prospective Investigation into Cancer - Oxford(EPIC-Oxford), UK Biobank and Million Women Study, and adults and children aged 5 and over from the National Diet and Nutrition Survey (NDNS).Primary and secondary outcome measures risk of total mortality from Cox proportional hazards regression models, total greenhouse gas emissions (GHGe) and blue water footprint (WF) associated with 'very low' (0-2 recommendations), 'low' (3-4 recommendations) or 'intermediate-to-high' (5-9 recommendations) adherence to EWG recommendations. RESULTS: Less than 0.1% of the NDNS sample adhere to all nine EWG recommendations and 30.6% adhere to at least five recommendations. Compared with 'very low' adherence to EWG recommendations, 'intermediate-to-high adherence' was associated with a reduced risk of mortality (risk ratio (RR): 0.93; 99% CI: 0.90 to 0.97) and -1.6 kg CO2eq/day (95% CI: -1.5 to -1.8), or 30% lower dietary GHGe. Dietary WFs were similar across EWG adherence groups. Of the individual Eatwell guidelines, adherence to the recommendation on fruit and vegetable consumption was associated with the largest reduction in total mortality risk: an RR of 0.90 (99% CI: 0.88 to 0.93). Increased adherence to the recommendation on red and processed meat consumption was associated with the largest decrease in environmental footprints (-1.48 kg CO2eq/day, 95% CI: -1.79 to 1.18 for GHGe and -22.5 L/day, 95% CI: -22.7 to 22.3 for blue WF). CONCLUSIONS: The health and environmental benefits of greater adherence to EWG recommendations support increased government efforts to encourage improved diets in the UK that are essential for the health of people and the planet in the Anthropocene.

The impact of environmental changes on the yield and nutritional quality of fruits, nuts and seeds: a systematic review.

BACKGROUND: Environmental changes are predicted to threaten human health, agricultural production and food security. Whilst their impact has been evaluated for major cereals, legumes and vegetables, no systematic evidence synthesis has been performed to date evaluating impact of environmental change on fruits, nuts and seeds (FN&S) - valuable sources of nutrients and pivotal in reducing risks of non-communicable disease. METHODS: We systematically searched seven databases, identifying available published literature (1970-2018) evaluating impacts of water availability and salinity, temperature, carbon dioxide (CO2) and ozone (O3) on yields and nutritional quality of FN&S. Dose-response relationships were assessed and, where possible, mean yield changes relative to baseline conditions were calculated. RESULTS: 81 papers on fruits and 24 papers on nuts and seeds were identified, detailing 582 and 167 experiments respectively. A 50% reduction in water availability and a 3-4dS/m increase in water salinity resulted in significant fruit yield reductions (mean yield changes: -20.7% [95%CI -43.1% to -1.7%]; and -28.2% [95%CI -53.0% to -3.4%] respectively). A 75-100% increase in CO2 concentrations resulted in positive yield impacts (+37.8%; [95%CI 4.1% to 71.5%]; and 10.1%; [95%CI -30.0% to 50.3%] for fruits and nuts respectively). Evidence on yield impacts of increased O3 concentrations and elevated temperatures (>25°C) was scarce, but consistently negative. The positive effect of elevated CO2 levels appeared to attenuate with simultaneous exposure to elevated temperatures. Data on impacts of environmental change on nutritional quality of FN&S were sparse, with mixed results. DISCUSSION: In the absence of adaptation strategies, predicted environmental changes will reduce yields of FN&S. With global intake already well-below WHO recommendations, declining FN&S yields may adversely affect population health. Adaptation strategies and careful agricultural and food system planning will be essential to optimise crop productivity in the context of future environmental changes, thereby supporting and safeguarding sustainable and resilient food systems.

United Kingdom's fruit and vegetable supply is increasingly dependent on imports from climate-vulnerable producing countries.

The contribution of domestic production to total fruit and vegetable supply in the UK decreased from 42% in 1987 to 22% in 2013. The impact of this changing pattern of UK fruit and vegetable imports from countries with different vulnerabilities to projected climate change on the resilience of the UK food system is currently unknown. Here, we used the Food and Agriculture Organization of the United Nations (FAO) bilateral trade database over a period of 27 years to estimate changes in fruit and vegetable supply in the UK and the Notre Dame Global Adaptation Initiative (ND-GAIN) climate vulnerability categories to assess the climate vulnerability of countries supplying fruit and vegetables to the UK. The diversity of fruit and vegetable supply has increased. In 1987, 21 crops constituted the top 80% of all fruit and vegetables supplied to the UK; in 2013, it was 34 crops. The contribution of tropical fruits has rapidly increased while that of more traditional vegetables, such as cabbages and carrots, has declined. The proportion of fruit and vegetables supplied to the UK market from climate-vulnerable countries increased from 20% in 1987 to 32% in 2013. Sensitivity analyses using climatic and freshwater availability indicators supported these findings. Increased reliance on fruit and vegetable imports from climate-vulnerable countries could negatively affect the availability, price and consumption of fruit and vegetables in the UK, affecting dietary intake and health, particularly of older people and low-income households. Inter-sectoral actions across agriculture, health, environment and trade are critical in both the UK and countries that export to the UK to increase the resilience of the food system and support population health.

Analysis of dietary patterns and cross-sectional and longitudinal associations with hypertension, high BMI and type 2 diabetes in Peru.

OBJECTIVE: To determine if specific dietary patterns are associated with risk of hypertension, type 2 diabetes mellitus (T2DM) and high BMI in four sites in Peru. DESIGN: We analysed dietary patterns from a cohort of Peruvian adults in four geographical settings using latent class analysis. Associations with prevalence and incidence of hypertension, T2DM and high BMI were assessed using Poisson regression and generalised linear models, adjusted for potential confounders. SETTING: Four sites in Peru varying in degree of urbanisation. PARTICIPANTS: Adults aged ≥35 years (n 3280). RESULTS: We identified four distinct dietary patterns corresponding to different stages of the Peruvian nutrition transition, reflected by the foods frequently consumed in each pattern. Participants consuming the 'stage 3' diet, characterised by high proportional consumption of processed foods, animal products and low consumption of vegetables, mostly consumed in the semi-urban setting, showed the highest prevalence of all health outcomes (hypertension 32·1 %; T2DM 10·7 %; high BMI 75·1 %). Those with a more traditional 'stage 1' diet characterised by potato and vegetables, mostly consumed in the rural setting, had lower prevalence of hypertension (prevalence ratio; 95 CI: 0·57; 0·43, 0·75), T2DM (0·36; 0·16, 0·86) and high BMI (0·55; 0·48, 0·63) compared with the 'stage 3' diet. Incidence of hypertension was highest among individuals consuming the 'stage 3' diet (63·75 per 1000 person-years; 95 % CI 52·40, 77·55). CONCLUSIONS: The study found more traditional diets were associated with a lower prevalence of three common chronic diseases, while prevalence of these diseases was higher with a diet high in processed foods and low in vegetables.

Future diets in India: A systematic review of food consumption projection studies.

Against a backdrop of a rapidly changing food system and a growing population, characterisation of likely future diets in India can help to inform agriculture and health policies. We systematically searched six published literature databases and grey literature repositories up to January 2018 for studies projecting the consumption of foods in India to time points beyond 2018. The 11 identified studies reported on nine foods up to 2050: the available evidence suggests projected increases in per capita consumption of vegetables, fruit and dairy products, and little projected change in cereal (rice and wheat) and pulse consumption. Meat consumption is projected to remain low. Understanding and mitigating the impacts of projected dietary changes in India is important to protect public health and the environment.