Environmental impact and nutritional quality of adult diet in France based on fruit and vegetable intakes.

PURPOSE: To describe the nutritional quality and environmental impact of self-selected diets of adults in France in relation to their fruit and vegetable (FV) intakes. METHODS: Estimates of food and nutrient intakes were taken from the national INCA3 Survey on food intakes carried out in France in 2014-2015. The population (n = 2121 adults) was split into five quintiles of FV intakes, in g/d (Q1 representing the lowest intake, and Q5 the highest). The nutritional quality of diets was assessed through 4 indicators: mean adequacy ratio (MAR), solid energy density, mean excess ratio (MER) and Programme National Nutrition Santé guideline score 2 (PNNS-GS2). The environmental impacts were measured with environmental footprint (EF) scores and 4 additional indicators: climate change, ozone depletion, fine particulate matter and water use. Indicators were compared between quintiles. Analysis was conducted on diets adjusted to 2000 kcal. RESULTS: MAR and PNNS-GS2 increased with increased FV quintiles, while solid energy density decreased. Fibre, potassium, vitamin B9 and vitamin C densities increased with increasing FV intakes. Climate change, ozone depletion and fine particulate matter impacts of diets decreased with increasing quintiles of FV consumption. Conversely, water use impact increased. CONCLUSION: Higher intake of FV is associated with higher nutritional quality of diets and lower environmental impact, except for water use. Given the benefits of fruit and vegetables for human health and the environment, their negative impact on water use could be improved by working on the agricultural upstream, rather than by changing individuals' food choices and reducing their consumption.

Mainstreaming traditional fruits, vegetables and pulses for nutrition, income, and sustainability in sub-Saharan Africa: the case for Kenya and Ethiopia.

This study documented existing knowledge on traditional fruits, vegetables and pulses in Kenya and Ethiopia. The aim was to identify neglected and underutilized species with high potential for food security, for their economic value and contribution to sustainable agriculture, based on a literature review and confirmation of existing data by local experts. In order of priority, the top 5 fruit species in Kenya are Tamarindus indica L., Adansonia digitata L., Sclerocarya birrea (A.Rich.) Hochst, Balanites aegyptiaca (L.) Delile, and Ziziphus mauritiana Lam., for vegetables are Amaranthus spp., Vigna unguiculata (L.) Walp., Solanum spp., and Cleome gynandra L. Top fruits in Ethiopia are Balanites aegyptiaca (L.) Delile, Ziziphus spina-christi (L.) Desf., Cordeauxia edulis Hemsl., Cordia africana Lam., and Mimusops kummel A. DC., for vegetables are Brassica carinata A. Braun, Cucurbita pepo L., and Amaranthus spp. In both countries, priority pulse species (no ranking) are Phaseolus lunatus L., Sphenostylis stenocarpa (A.Rich.) Harms, Mucuna pruriens (L.) DC., Lablab purpureus (L.) Sweet, and Cajanus cajan (L.) Millsp. Generally, these priority species are good sources of key nutrients known for their inadequate dietary intakes in sub-Saharan Africa, represent a safety net for household income, and contribute positively to ecosystem resilience in existing agricultural systems. Complete, accurate and reliable nutrient composition data are needed to raise consumer awareness about their nutritional and health benefits. Since women play a central role in traditional food systems, their empowerment, and hence resilience, increase the positive impact they can have on the households' dietary diversity. In particular, introducing small-scale processing techniques and marketing strategies could enhance their supply and consumption.

Sustainability analysis of the Mediterranean diet: results from the French NutriNet-Santé study.

The Mediterranean diet is often proposed as a sustainable diet model. This study aimed to evaluate the associations between adherence to the Mediterranean diet and sustainability domains in a cohort of French adults, using multiple criteria including nutritional quality, environmental pressures, monetary cost and dietary pesticide exposure. Food intakes of 29 210 NutriNet-Santé volunteers were assessed in 2014 using a semi-quantitative FFQ. Adherence to the Mediterranean diet was evaluated using the validated literature-based adherence score (MEDI-LITE). The associations between the MEDI-LITE and various sustainability indicators were examined using ANCOVA models, adjusted for sex, age and energy intake. Higher adherence to the MEDI-LITE was associated with higher nutritional quality scores, better overall nutrient profile as well as reduced environmental impact (land occupation: Q5 v. Q1: -35 %, greenhouse gas emissions: -40 % and cumulative energy demand: -17 %). In turn, monetary cost increased with increasing adherence to the Mediterranean diet (Q5 v. Q1: +15 %), while higher adherents to the Mediterranean diet had overall higher pesticide exposure due to their high plant-based food consumption. In this large cohort of French adults, greater adherence to the Mediterranean diet was associated with nutritional and environmental benefits, but also with higher monetary cost and greater exposure to pesticides, illustrating the necessity to develop large-scale strategies for healthy, safe (pesticide- and contaminant-free) and environmentally sustainable diets for all.

Horsemeat consumption in France: Determinants and sustainable market perspectives.

In France, the horsemeat market has been declining for about 50 years and has become a specialized market. Our study aims to understand this decline with regard to the drivers and practices of consumers and non-consumers of this meat, in order to estimate the potential for this market development. To study horsemeat consumption, we analyze two sets of data: two large-scale surveys carried out on the French general population, and one ad-hoc survey focusing more specifically on the representations of horses and horsemeat. Our results underline the potential for increasing horsemeat consumption from a sustainability perspective. The question of moral acceptance remains a determining factor in the consumption of this meat. Once this factor is taken into account, horsemeat appears relevant in the diversification of animal protein consumption because of its particular nutritional and environmental properties and similar culinary use to that of other red meats. Horsemeat can thus lay claim to becoming a sustainable alternative to beef consumption.

Vitamin D Supplementation on Carotid Remodeling and Stiffness in Obese Adolescents.

Obesity is associated with vitamin D (VD) deficiency and arterial stiffness. This randomized control trial assessed the effects of VD supplementation during a weight-loss program on carotid intima-media thickness (IMT) and carotid compliance in obese adolescents. Participants were randomly assigned to receive either a 12-week lifestyle program with VD supplementation (n = 13), a lifestyle program without VD supplementation (n = 13) or a control group composed of normal-weight adolescents (n = 18). Serum total and free 25-hydroxyvitamin D (25(OH)D), IMT and carotid compliance were measured before and after the trial. Insufficiency in 25(OH)D concentration was found in 73% of obese participants compared to 22% among controls. Obese adolescents had lower free 25(OH)D and displayed higher IMT but lower carotid compliance than controls. Free 25(OH)D and IMT were negatively correlated in adolescents displaying VD insufficiency at baseline. After three months, total and free 25(OH)D increased in both groups. The changes of IMT and carotid compliance were similar between groups. The changes in IMT were correlated with the changes in total 25(OH)D in obese adolescents with VD insufficiency at baseline (r = -0.59, p = 0.03). While the lifestyle program with VD supplementation did not affect carotid compliance, IMT reduction was improved in obese adolescents.

Clinical Evidence of the Benefits of Phytonutrients in Human Healthcare.

Phytonutrients comprise many different chemicals, including carotenoids, indoles, glucosinolates, organosulfur compounds, phytosterols, polyphenols, and saponins. This review focuses on the human healthcare benefits of seven phytochemical families and highlights the significant potential contribution of phytonutrients in the prevention and management of pathologies and symptoms in the field of family health. The structure and function of these phytochemical families and their dietary sources are presented, along with an overview of their potential activities across different health and therapeutic targets. This evaluation has enabled complementary effects of the different families of phytonutrients in the same area of health to be recognized.

Key Findings of the French BioNutriNet Project on Organic Food-Based Diets: Description, Determinants, and Relationships to Health and the Environment.

Few studies have investigated the relationships between organic food consumption, dietary patterns, monetary diet cost, health, and the environment. To address these issues, a consortium of French epidemiologists, nutritionists, economists, and toxicologists launched the BioNutriNet project in 2013. In 2014, an FFQ documented the usual organic and nonorganic (conventional) food consumption of approximately 35,000 NutriNet-Santé participants. Then, individual organic and conventional food intakes were merged with price, environmental, and pesticide residue data sets, which distinguished between conventional and organic farming methods. Many studies were conducted to characterize organic consumers and their environmental impacts (i.e., greenhouse gas emissions, energy demand, and land use) and organic food consumption impacts on health. We observed that organic consumers had diets that were healthier and richer in plant-based food than nonorganic consumers. Their diets were associated with higher monetary costs, lower environmental impacts, and reduced exposure to certain pesticide residues. Regular consumption of organic food was associated with reduced risks of obesity, type 2 diabetes, postmenopausal breast cancer, and lymphoma. Although several observations have been confirmed by several studies conducted in other countries, our results should be replicated in other cultural settings and coupled with experimental studies to be able to draw causal conclusions. Finally, the main finding of the BioNutriNet project is that while organic food consumption could be associated with positive externalities on human health and the environment, organic-based diets should be accompanied by dietary shifts toward plant-based diets to allow for better planetary and human health.

Changes in French purchases of pulses during an FAO awareness campaign.

Background: Pulses can play a key role in a well-balanced diet and are now recognized for their health and sustainability benefits. However, consumption remains quite low, motivating promotion efforts such as the "International Year of Pulses" declared by the Food and Agriculture Organization (FAO) in 2016. The present study aims to evaluate the changes in the purchase of pulses before and after the FAO's awareness campaign promoting the consumption of pulses in France and investigate the potential differences across sub-populations. Methods: Purchase data come from Kantar Worldpanel 2014-2017. First, in order to understand demand for pulses, the influence of sociodemographic variables on the purchase of pulses in different forms (raw, processed, ultra-processed) is analyzed using a Box-Cox heteroskedastic double-hurdle model. Then, changes in purchasing before and after the FAO campaign were estimated using a two-way fixed-effects model, controlling for price and sociodemographic variables. Results: On that period, the purchasing of pulses increased by 8.4% overall. The increase was greater for younger participants (+11.8%), people living in urban areas with over 200,000 inhabitants (+8.4%), and lower-income households (+7.1%). The 8.4% increase observed indicated that there were gradual preference change in favor of pulses and the impact of the awareness campaign was to boost expenditure on pulses by a further 2%. Conclusion: The FAO campaign coincided with an increase in the purchasing of pulses and may have had an enhancing effect. However, consumption still remains below the level advised by dietary guidelines. There is a need for more public information and communication on the health and sustainability benefits of pulses, the consumption of which can be promoted through supply and education interventions. JEL codes: D12; Q18; I18.

Intake Estimation of Phytochemicals in a French Well-Balanced Diet.

Phytochemicals contribute to the health benefits of plant-rich diets, notably through their antioxidant and anti-inflammatory effects. However, recommended daily amounts of the main dietary phytochemicals remain undetermined. We aimed to estimate the amounts of phytochemicals in a well-balanced diet. A modelled diet was created, containing dietary reference intakes for adults in France. Two one-week menus (summer and winter) were devised to reflect typical intakes of plant-based foods. Existing databases were used to estimate daily phytochemical content for seven phytochemical families: phenolic acids, flavonoids (except anthocyanins), anthocyanins, tannins, organosulfur compounds, carotenoids, and caffeine. The summer and winter menus provided 1607 and 1441 mg/day, respectively, of total polyphenols (phenolic acids, flavonoids, anthocyanins, and tannins), the difference being driven by reduced anthocyanin intake in winter. Phenolic acids, flavonoids (including anthocyanins), and tannins accounted for approximately 50%, 25%, and 25% of total polyphenols, respectively. Dietary carotenoid and organosulfur compound content was estimated to be approximately 17 and 70 mg/day, respectively, in both seasons. Finally, both menus provided approximately 110 mg/day of caffeine, exclusively from tea and coffee. Our work supports ongoing efforts to define phytochemical insufficiency states that may occur in individuals with unbalanced diets and related disease risk factors.

Demographic and socio-economic shifts partly explain the Martinican nutrition transition: an analysis of 10-year health and dietary changes (2003-2013) using decomposition models.

OBJECTIVE: The Caribbean has seen a dramatic shift in the obesity and chronic disease prevalence over the past decades, suggesting a nutrition transition. Simultaneously, Martinique has faced a demographic transition marked by significant population ageing. We aimed to differentiate the contribution of changes in health status and dietary intakes due to shifts in demographic and socio-economic characteristics (DSEC) from that due to unobserved factors. DESIGN: Two cross-sectional surveys conducted in 2003 (n 743) and 2013 (n 573) on representative samples were used. Dietary intakes were estimated by 24-h recalls. The contribution of changes in health status and dietary intakes due to shifts in observed DSEC was differentiated from that due to unobserved factors over a 10-year interval, using Oaxaca-Blinder decomposition models. SETTING: Martinique, French region in the Caribbean. PARTICIPANTS: Martinican adults (≥16 years). RESULTS: Over the study period, health status deteriorated, partly owing to shifts in DSEC, explaining 62 % of the change in the prevalence of hypertension (+13 percentage points (pp)) and 48 % of waist circumference change (+3 cm). Diet quality decreased (mean adequacy ratio -2pp and mean excess ratio + 2 pp) and energy supplied by ultra-processed food increased (+4 pp). Shifts in DSEC marginally explained some changes in dietary intakes (e.g. increased diet quality), while the changes that remained unexplained were of opposite sign, with decreased diet quality, lower fruits, tubers and fish intakes and higher energy provided by ultra-processed foods. CONCLUSION: Explained dietary changes were of opposite sign to nutrition transition conceptual framework, probably because unobserved drivers are in play, such as food price trends or supermarkets spread.

Effect of vitamin D supplementation on microvascular reactivity in obese adolescents: A randomized controlled trial.

BACKGROUND AND AIM: Childhood obesity is associated with vitamin D (VD) deficiency and vascular dysfunction. Considering evidence indicates that VD may improve vascular function, this study, for the first time, assessed the effect of VD supplementation on microvascular reactivity in obese adolescents (OA). METHODS AND RESULTS: This randomized controlled trial included 26 OA, receiving fruit juice with (n = 13) or without VD (4000 IU/d; n = 13) over a 3-month lifestyle program, as well as 23 normal-weight adolescents (controls). The primary outcome was the pre-to-post-program change in microvascular reactivity determined by laser speckle contrast imaging with acetylcholine and sodium nitroprusside iontophoresis. Changes in 25 hydroxyvitamin D (25(OH)D), flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), insulin resistance (HOMA-IR) and inflammatory markers (C-reactive protein [CRP]) were monitored. At inclusion, in comparison to controls, OA exhibited lower total and free 25(OH)D, impaired microvascular responses, and impaired FMD, but similar NMD. After the lifestyle program, total and free 25(OH)D increased in all OA, with a greater increase in those receiving VD supplements. HOMA-IR and CRP decreased in all OA. Neither FMD nor NMD were altered in either group. Endothelium-dependent microvascular reactivity only increased in the VD-supplemented group, reaching values comparable to that of controls. Similar results were found when analyzing only OA with a VD deficiency at baseline. CONCLUSION: VD supplementation during a lifestyle program attenuated microvascular dysfunction in OA without altering macrovascular function. REGISTRATION NUMBER FOR CLINICAL TRIAL: NCT02400151.

Caribbean nutrition transition: what can we learn from dietary patterns in the French West Indies?

PURPOSE: Despite the urgency regarding increasing rates of obesity and chronic diseases in the Caribbean, few studies described the nutrition transition. We aimed to provide such information by identifying dietary patterns in the French West Indies and their characteristics. METHODS: This cross-sectional analysis included 1144 Guadeloupeans and Martinicans from a multistage sampling survey conducted on a representative sample. Dietary patterns were identified using principal component analysis followed by a clustering procedure, and described using multivariable regression models. RESULTS: Four patterns were identified: (i) a "prudent" pattern characterized by high intakes of fruits, vegetables, legumes, seafood and yogurts, low intakes of fatty and sweet products, and a high Diet Quality Index-International (DQI-I); (ii) a "traditional" pattern characterized by high intakes of fruits, vegetables, tubers and fish, low intakes of red and processed meat, snacks, fast foods, and sweetened beverages, with a high DQI-I, mostly shaped by women and older persons; (iii) a "convenient" pattern characterized by high intakes of sweetened beverages, snacks, and fast foods, with the lowest DQI-I, principally shaped by young participants; (iv) a "transitioning" pattern characterized by high consumptions of bread, processed meat, sauces, alcoholic and sweetened beverages, but also high intakes of tubers, legumes, and fish, mainly shaped by men, middle aged, of whom 35% had metabolic syndrome. CONCLUSION: The co-existing dietary patterns in the French West Indies, marked by a generational contrast, seem to reflect different steps in dietary change as described in the literature, suggesting an ongoing nutrition transition.

Socioeconomic inequalities in metabolic syndrome in the French West Indies.

BACKGROUND: Obesity and metabolic diseases represent a major health burden in the Caribbean, particularly since a large part of the population is disadvantaged. However, socioeconomic inequalities in chronic diseases are poorly explored in this region. We investigated the association between socioeconomic position and metabolic syndrome (MetS) prevalence and explored the contribution of diet quality to explain this association, among adults in the French West Indies. METHODS: This cross-sectional analysis included 1144 subjects (≥16 y) from a multistage sampling survey conducted in 2013-2014 on a representative sample of the Guadeloupean and Martinican population. MetS prevalence was assessed using the Joint Interim Statement. Dietary intakes were estimated from 24 h-dietary recalls, and diet quality was assessed through the Diet Quality Index-International (DQI-I). Associations between socioeconomic indicators (education, employment, social assistance benefits) and MetS prevalence, and the potential contribution of diet quality in this association were assessed using multivariable logistic regression models, adjusted for sociodemographic characteristics. RESULTS: MetS prevalence adjusted for age and sex was 21 and 30% among Guadeloupean and Martinican, respectively. Compared to high-educated participants, low-educated subjects were more likely to be at risk of MetS (OR = 2.4; 95%CI = [1.3-4.4], respectively), as were recipients of social assistance benefits compared to non-recipients (OR = 2.0; 95%CI = [1.0-4.0]). The DQI-I explained 10.5% of the overall variation in MetS due to education. CONCLUSIONS: Socioeconomic inequalities in MetS prevalence, reflected by education and social assistance benefits, were found. However, diet quality contributed only to socioeconomic inequalities due to education underlining that education may impact health through the ability to generate overall dietary behavior, long-term beneficial. Our work identified subgroups with higher risk of MetS, which is needed when implementing public health measures, particularly in this Caribbean population with of high poverty rates. Further prospective studies are needed to improve our understanding of the mechanisms of social inequalities in MetS in a high poverty rates context.

Dataset on potential environmental impacts of water deprivation and land use for food consumption in France and Tunisia.

The dataset concerns the environmental impacts of water consumption and land use caused by 1 kg of food item supplied to two Mediterranean countries: France and Tunisia. The dataset takes into account the food items available in France and Tunisia (identified in two national dietary surveys) and their origin. Water consumption and land use surfaces were extracted from existing databases and from national data for animal feed description. Up-to-date available evaluation methods were used to assess the associated impacts. The origin of ingredients was considered to compute impacts on all countries of the world. These data were used in Perignon et al., 2019 [1].

Improvement of diet sustainability with increased level of organic food in the diet: findings from the BioNutriNet cohort.

BACKGROUND: Organic food consumption has steadily increased over the past decade in westernized countries. OBJECTIVE: The aim of this study, based on observational data, was to compare some sustainability features of diets from consumers with varying levels of organic food. METHODS: The diet sustainability among 29,210 participants of the NutriNet-Santé study was estimated using databases developed within the BioNutriNet project. Four dimensions (nutrition, environment, economy, and toxicology) of diet sustainability were assessed using: 1) nutritional indicators through dietary intakes and dietary scores, and BMI; 2) environmental indicators (greenhouse gas emissions, cumulative energy demand, and land occupation); 3) economic indicators via diet monetary costs; and 4) estimated daily food exposures to 15 pesticides. Adjusted means (95% CI) across weighted quintiles of organic food consumption in the diet were estimated via ANCOVA. Breakdown methods were used to disentangle the contribution of the production system (organic compared with conventional) from the dietary pattern in the variation of diet-related environmental impacts, monetary costs, and pesticide exposure, between the 2 extreme quintiles. RESULTS: Higher organic food consumption was associated with higher plant-food and lower animal-food consumption, overall nutritional quality (higher dietary scores), and lower BMI. Diet-related greenhouse-gas emissions, cumulative energy demand, and land occupation gradually decreased with increasing organic food consumption, whereas total diet monetary cost increased. Diet exposure to most pesticides decreased across quintiles. CONCLUSIONS: Diets of high organic food consumers were generally characterized by strong nutritional and environmental benefits. The latter were mostly driven by the low consumption of animal-based foods, whereas the production system was responsible for the higher diet monetary costs, and the overall reduced dietary pesticide exposure.

Some Differences in Nutritional Biomarkers are Detected Between Consumers and Nonconsumers of Organic Foods: Findings from the BioNutriNet Project.

BACKGROUND: Meta-analyses have compared the nutrient content of both organic and nonorganic foods. However, the impacts of such variations on human nutritional biomarkers still need to be assessed. OBJECTIVE: In a nested clinical study from the NutriNet-Santé study, we aimed to compare the nutritional status of "organic" and "nonorganic" food consumers matched on a propensity score. METHODS: Based on self-reported organic food consumption assessed through a food frequency questionnaire (FFQ), 150 low and 150 high organic food consumers were selected with <10% or >50% of organic food in their diet, respectively (expressed as the proportion of organic food in the whole diet in g/d). Participants were matched using a propensity score derived from socio-demographic, food, and health variables. Fasting plasma samples were analyzed using acknowledged laboratory methods for measurements of iron status, magnesium, copper, cadmium, carotenoids, vitamins A and E, and fatty acids. RESULTS: We found significant differences between low and high organic food consumers with similar dietary patterns, with respect to plasma concentrations of magnesium, fat-soluble micronutrients (α-carotene, ß-carotene, lutein, and zeaxanthin), fatty acids (linoleic, palmitoleic, γ-linolenic, and docosapentanoeic acids), and some fatty acid desaturase indexes. No differences between the 2 groups were detected for plasma concentrations of iron, copper, cadmium, lycopene, ß-cryptoxanthin, or vitamins A and E. CONCLUSION: If confirmed by other studies, our data suggest that a high consumption of organic foods, compared with very low consumption, modulates to some extent, the nutritional status of individuals with similar dietary patterns. Further research including prospective cohort studies is needed to evaluate the clinical relevance of such differences.

Nutritional Composition and Bioactive Content of Legumes: Characterization of Pulses Frequently Consumed in France and Effect of the Cooking Method.

Pulses display nutritional benefits and are recommended in sustainable diets. Indeed, they are rich in proteins and fibers, and can contain variable amounts of micronutrients. However, pulses also contain bioactive compounds such as phytates, saponins, or polyphenols/tannins that can exhibit ambivalent nutritional properties depending on their amount in the diet. We characterized the nutritional composition and bioactive compound content of five types of prepared pulses frequently consumed in France (kidney beans, white beans, chickpeas, brown and green lentils, flageolets), and specifically compared the effects of household cooking vs. canning on the composition of pulses that can be consumed one way or the other. The contents in macro-, micronutrients, and bioactive compounds highly varied from one pulse to another (i.e., 6.9 to 9.7 g/100 g of cooked product for proteins, 4.6 to 818.9 µg/100 g for lutein or 15.0 to 284.3 mg/100 g for polyphenols). The preparation method was a key factor governing pulse final nutritional composition in hydrophilic compounds, depending on pulse species. Canning led to a greater decrease in proteins, total dietary fibers, magnesium or phytate contents compared to household cooking (i.e., -30%, -44%, -33% and -38%, p < 0.05, respectively, in kidney beans). As canned pulses are easy to use for consumers, additional research is needed to improve their transformation process to further optimize their nutritional quality.

A "Fork-to-Farm" Multi-Scale Approach to Promote Sustainable Food Systems for Nutrition and Health: A Perspective for the Mediterranean Region.

Mediterranean countries are undergoing dietary and nutritional changes that affect their inhabitants' health, while facing massive environmental challenges. The increasing demand of water in agriculture, the capacity to maintain local food production, and the growing dependence on food imports are interconnected issues that must be addressed to ensure food security and nutrition in the Mediterranean region. Here, we present the conceptual framework and methodologies developed by the MEDINA-Study Group for rethinking food systems toward sustainable consumption and production modes. Based on its multidisciplinary expertise, the MEDINA-Study Group designed a "fork-to-farm" multi-scale approach, stemming from current dietary habits and examining how some options to nutritionally improve these habits might affect the food systems. This approach was developed for research activities in the South of France and Tunisia, two areas with very different diet-agriculture-environment nexus. The conceptual framework is based on the analysis of elements of the food systems (from consumption to production) at different levels (individual, household, regional and national levels). The methods include: (i) modeling options of dietary changes at different scales, in order to nutritionally optimize food consumption-production without increasing the environmental impact, (ii) translating the best-choice changes into possible policy actions, (iii) testing the acceptability and feasibility of these actions with several stakeholders, and (iv) producing guidelines for sustainable food choices and production. The MEDINA-Study Group identified additional issues that could be included in a future framework to help designing ambitious agricultural, food and health policies in the Mediterranean region.

Effects of cooking and food matrix on estimated mineral bioavailability in Mloukhiya, a Mediterranean dish based on jute leaves and meat.

Traditional Mediterranean plant-based dishes could allow tackling malnutrition while preserving the cultural heritage. To determine the effect of the cooking method on mineral bioavailability, the content in minerals and chelators of Mloukhiya, a Mediterranean dish based on jute leaves (Corchorus olitorius) that contains also meat, was monitored during the whole cooking process. Mineral bioaccessibility was assessed by measuring in vitro dialyzability. Model equation was also used to estimate mineral bioavailability. Comparison of Mloukhiya samples collected at different cooking time points showed that the dish total mineral content did not change despite the exchanges between sauce and meat during cooking. However, iron bioavailability decreased, because 58% of heme iron was degraded after 5h of cooking and non-heme iron showed poor bioaccessibility (1.2%), mainly due to its high content of phenolic compounds. The bioaccessibility of other minerals (zinc, calcium, magnesium and potassium) was high, indicating that the food matrix had no or little effect. The mineral bioavailability values predicted by using mathematical models were of the same order of magnitude as the bioaccessibility values.