Toward healthy and sustainable diets for the 21st century: Importance of sociocultural and economic considerations.

Four years after the EAT-Lancet landmark report, worldwide movements call for action to reorient food systems to healthy diets that respect planetary boundaries. Since dietary habits are inherently local and personal, any shift toward healthy and sustainable diets going against this identity will have an uphill road. Therefore, research should address the tension between the local and global nature of the biophysical (health, environment) and social dimensions (culture, economy). Advancing the food system transformation to healthy, sustainable diets transcends the personal control of engaging consumers. The challenge for science is to scale-up, to become more interdisciplinary, and to engage with policymakers and food system actors. This will provide the evidential basis to shift from the current narrative of price, convenience, and taste to one of health, sustainability, and equity. The breaches of planetary boundaries and the environmental and health costs of the food system can no longer be considered externalities. However, conflicting interests and traditions frustrate effective changes in the human-made food system. Public and private stakeholders must embrace social inclusiveness and include the role and accountability of all food system actors from the microlevel to the macrolevel. To achieve this food transformation, a new "social contract," led by governments, is needed to redefine the economic and regulatory power balance between consumers and (inter)national food system actors.

Heterogeneity in diet-related non-communicable disease risks in a Chinese population.

PURPOSE: Sub-optimal food choices contribute to the risk of multiple non-communicable diseases (NCDs) which can be mitigated by improving diet quality. Food consumption patterns may partly account for variation of NCD risks in population subgroups in China. This study aimed to evaluate the risk of diet-related NCDs of observed Chinese diets, and to assess the potential reduction in NCD risks by adhering to certain diet recommendations. METHODS: Dose-response meta-analyses were used to derive relative risks between three diet-related NCDs and consumption of 15 food groups. 24-h dietary recall data of 12,809 adults from the 2011 China Health and Nutrition Survey were used to estimate the diet-related summed risks (SRs) of NCDs. Twelve Chinese provinces were aggregated into five regions, and stratified by age, gender, overweight status, education, income, and urbanicity. The Chinese Dietary Guideline-2016 (CDG-2016) and the EAT-Lancet diet were used as recommended diets. RESULTS: Associations between SRs and gender, age, educational level, income level, and urbanicity were observed. No association was found between SRs and overweight status. Both diet recommendations have lower SRs compared to observed diets among all regions. The food groups that contributed most to the variation of the SRs of diet-related NCDs in China were high consumption of red meat and refined grains, and low consumption of whole grains, fruits, and legumes. CONCLUSION: To address the heterogeneity in diet-related NCD risks, focusing on region-specific dietary practical is imperative for Chinese population, in order to propose tailored guidance to adhere to diet recommendations.

Cross-provincial inpatient mobility patterns and their determinants in China.

BACKGROUND: The incongruity between the regional supply and demand of healthcare services is a persistent challenge both globally and in China. Patient mobility plays a pivotal role in addressing this issue. This study aims to delineate the cross-provincial inpatient mobility network (CIMN) in China and identify the underlying factors influencing this CIMN. METHODS: We established China's CIMN by applying a spatial transfer matrix, utilizing the flow information from 5,994,624 cross-provincial inpatients in 2019, and identified the primary demand and supply provinces for healthcare services. Subsequently, we employed GeoDetector to analyze the impact of 10 influencing factors-including medical resources, medical quality, and medical expenses-on the spatial patterns of CIMN. FINDINGS: Beijing, Shanghai, Zhejiang, and Jiangsu provinces are the preferred medical destinations for cross-provincial inpatients, while Anhui, Henan, Hebei, and Jiangsu provinces are the main sources for cross-provincial inpatients. Patient flow between provinces decreases with distance. The spatial distribution of medical resources, medical quality, and medical expenses account for 87%, 73%, and 56% of the formation of CIMN, respectively. Additionally, interactions between these factors enhance explanatory power, suggesting that considering their interactions can more effectively optimize medical resources and services. CONCLUSIONS: The analysis of CIMN reveals the supply and demand patterns of healthcare services, providing insights into the inequality characteristics of healthcare access. Furthermore, understanding the driving factors and their interactions offers essential evidence for optimizing healthcare services.

Food systems for sustainable development: proposals for a profound four-part transformation.

Evidence shows the importance of food systems for sustainable development: they are at the nexus that links food security, nutrition, and human health, the viability of ecosystems, climate change, and social justice. However, agricultural policies tend to focus on food supply, and sometimes, on mechanisms to address negative externalities. We propose an alternative. Our starting point is that agriculture and food systems' policies should be aligned to the 2030 Agenda for Sustainable Development. This calls for deep changes in comparison with the paradigms that prevailed when steering the agricultural change in the XXth century. We identify the comprehensive food systems transformation that is needed. It has four parts: first, food systems should enable all people to benefit from nutritious and healthy food. Second, they should reflect sustainable agricultural production and food value chains. Third, they should mitigate climate change and build resilience. Fourth, they should encourage a renaissance of rural territories. The implementation of the transformation relies on (i) suitable metrics to aid decision-making, (ii) synergy of policies through convergence of local and global priorities, and (iii) enhancement of development approaches that focus on territories. We build on the work of the "Milano Group," an informal group of experts convened by the UN Secretary General in Milan in 2015. Backed by a literature review, what emerges is a strategic narrative linking climate, agriculture and food, and calling for a deep transformation of food systems at scale. This is critical for achieving the Sustainable Development Goals and the Paris Agreement. The narrative highlights the needed consistency between global actions for sustainable development and numerous local-level innovations. It emphasizes the challenge of designing differentiated paths for food systems transformation responding to local and national expectations. Scientific and operational challenges are associated with the alignment and arbitration of local action within the context of global priorities.

What exacerbates and what eases Chinese rural residents' depression during the COVID-19?

During the COVID-19 pandemic, there has been a growing prevalence of mental disorders, particularly in China, where anti-epidemic measures have been more stringent compared to other countries. This has resulted in a heightened psychological burden on individuals. However, the actual psychological impacts of COVID-19 on Chinese residents have not been clearly established. In this study, we aimed to investigate the effects of various factors, including personal and household characteristics, social networks, and epidemic-related variables (such as rural residents' knowledge of COVID-19 virus transmission and prevention), on rural residents' depression. Using a two-year balanced panel dataset encompassing 152 villages and 676 samples in both 2019 and 2020, we employed the Ordinary Least Squares (OLS) model to estimate the influence of these factors and compare their coefficients to examine the changes in rural residents' depression between the pre-epidemic and during-epidemic periods. Our study highlights significant factors contributing to rural residents' depression during the COVID-19 pandemic, including isolation (2.063, p < 0.01) and concern about COVID-19 infection (0.128, p < 0.05). Conversely, factors such as health status (-0.714, p < 0.01) and the number of friends (-0.017, p < 0.01) were found to significantly alleviate depression among rural residents. Moreover, we identify key moderators that mitigate the negative impact of infection concerns on mental health. Specifically, the health status of rural residents (-0.166, p < 0.01), the size of their family network (-0.036, p < 0.05), and their knowledge of COVID-19 transmission and prevention (-0.184, p < 0.05) significantly moderated the relationship between infection concerns and depression. These findings contribute to a better understanding of the psychological implications of the pandemic and provide valuable insights for the development of targeted interventions to address mental health challenges in rural populations.

The Spatio-Temporal Evolution of Food Production and Self-Sufficiency in China from 1978 to 2020: From the Perspective of Calories.

Ensuring national food security is an eternal topic. We unified six categories of food with calorie content including grain, oil, sugar, fruits and vegetables, animal husbandry, and aquatic products on the basis of provincial-level data, and we dynamically evaluated caloric production capacity and the supply-demand equilibrium under the increase in feed-grain consumption as well as the food losses and waste in China from 1978 to 2020 at four different levels. The results show that: (1) From the perspective of food production, the total national calorie production showed a linear growth trend, with a growth rate of 31.7 × 1012 kcal/year, of which the proportion of grain crops has always exceeded 60%. Most provinces showed significant increasing trends in food calorific production, except for Beijing, Shanghai, and Zhejiang, which showed slightly decreasing trends. The distribution pattern of food calories and their growth rate were high in the east and low in the west. (2) From the perspective of the food supply-demand equilibrium, the national food calorie supply has been in surplus since 1992, but significant spatial heterogeneity is detected, with the Main Marketing Region changing from a tight balance to a short surplus, North China always remaining in calorie shortage, and 15 provinces still presenting supply and demand gaps up to 2020, necessitating the establishment of a more efficient and faster flow and trade system. (3) The national food caloric center has shifted 204.67 km to the northeast, and the population center has shifted to the southwest. The reverse migration of the centers of food supply and demand will further aggravate the pressure on water and soil resources and cause higher requirements for ensuring the circulation and trade system of food supply. The results are of great significance for the timely adjustment of agricultural development policies, making rational use of natural advantages and ensuring China's food security and sustainable agricultural development.

Women's Empowerment, Food Security, and Nutrition Transition in Africa.

Despite mounting recognition of the essential role of women's empowerment in household dietary and nutrition changes, the diversity of culture across African countries presents ambiguity as to whether its impact is experienced homogeneously across the continent. This article presents a systematic review of whether women's empowerment changes household dietary patterns, contributes to nutrition improvement, and consequently affects diet-related health outcomes in Africa. We find that whilst more research needs to be conducted, particularly with improved methodologies that can establish cause-effect relationships, there is consensus among the literature on the link between women's empowerment and some domains of food security and dietary improvement. Meanwhile, studies on women's empowerment and the additional demand pressure on some food categories are quite limited. This exacerbates the challenge of setting production plans that aim to address the continent's question of food.

Reshaping Food Policy and Governance to Incentivize and Empower Disadvantaged Groups for Improving Nutrition.

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated global malnutrition challenges, disrupted food supply chains, and left poor and vulnerable people unable to produce and access safe and affordable food, especially in developing countries. Food policy and governance are currently malfunctioning, despite their recognized roles in improving food security and public nutrition in many local and national contexts. This article reviews existing food policies and governance with implications for disadvantaged groups in the food systems, particularly smallholder farmers, women, and small- and medium-sized enterprises (SMEs), highlighting the importance of reshaping food policies and governance. To end malnutrition in the post-COVID era, multiple sectors, including health, agriculture, social protection, education, and infrastructure, must make greater collaborative efforts to develop and implement food and nutrition policies. Several recommendations for reshaping food policy interventions and governance are summarized.

Integrating agricultural diversification in China's major policies.

Agricultural diversification is proposed as a solution to achieve food security and sustainability in intensified agriculture, but a large-scale policy implementation is lacking. As a leading agricultural producer, the integration of diversification in major policies in China could provide an important example of how to facilitate a sustainable food system transformation globally.

How online food delivery platforms contributed to the resilience of the urban food system in China during the COVID-19 pandemic.

We use high-frequency data to quantify the nature and performance of online food delivery platforms during the COVID-19 pandemic in urban China, and to estimate the short- and long-term effects of lockdown and reopening measures. A staggered difference-in-differences (DID) estimation strategy and event study approach are used to identify the effects of lockdown and reopening measures on the performance of online food delivery platforms and restaurants. The results indicate that some restaurants continued to operate and offer online food delivery while lockdowns were in effect. Both the number of operating restaurants and their online food delivery services rebounded and experienced further growth after lockdowns were lifted. The adjustment path of the online food delivery business following the implementation of lockdowns differed from the adjustment path following the lifting of lockdowns. The lockdown and reopening measures did not affect all types of restaurant/cuisine equally. We also examine possible impact mechanisms of lockdown measures on online food delivery and restaurants, and conduct robustness checks to confirm the stability of the main findings. This study contributes to the existing literature by confirming the positive contribution of online food delivery to the resilience of urban food systems in response to unexpected external shocks. Our results have implications for the design of policies to guarantee food supply and help urban food systems adapt to unexpected shocks.

Environmental footprints of Chinese foods and beverages: Literature-based construction of a LCA database.

To accurately estimate and model the impact of food consumption and potential dietary changes on environment and climate change, the need for country specific data is evident. This study developed a Chinese Food Life Cycle Assessment Database (CFLCAD) in which Greenhouse Gas Emissions (GHGE) for 80 food items, Water Use (WU) for 93 food items and Land Use (LU) for 50 food items were collected through a literature review. To estimate the environmental footprints of food from production to consumption, the study applied conversion factors for the edible portion of food, food loss ratio and processing, storage, packaging, transportation, and food preparation stages. In addition, when no LCA data of a certain food was available, data from food groups with similar nutritional composition or cultivation condition were used as proxies. The database covered 17 food groups and each food item was referenced to the Chinese Food Composition Table and has a unique food code. The CFLCAD can be used to link individual-level food consumption data with nutrition survey in China, to allow for a more accurate estimation of the environmental footprints of Chinese diets.

Food system resilience and COVID-19 - Lessons from the Asian experience.

The impact of the COVID-19 pandemic on the food system has exposed the vulnerabilities of the supply chain, although the extent of disruption varies widely, globally and in Asia. However, food systems in Asia have been proven relatively resilient when compared with other regions. This paper considers the immediate effects of the COVID-19 pandemic on the food system, particularly in Asia, and initial responses of governments and global agencies to manage the crisis. A major focus of the paper is on the outlook for food system resilience in a post-COVID-19 environment and likely long-term effects of the pandemic. There is always a possibility of such shock events occurring in the future, hence it seems prudent to look at lessons that may be learned from the responses to the current pandemic.