Table 4.
Dietary quality scores, as an application of the dietary guidelines, in relation to environmental sustainability for a descriptive analysis on environmentally sustainable diets
| Health considerations | Environmental considerations | ||||||
|---|---|---|---|---|---|---|---|
| Reference | Country | Dietary data | Diet scores* | Nutritional indicators in diet scores | Health evaluation of whole diet based on | Food aggregation level† | Environmental indicator |
| Carvalho et al. (2013)( 51 ) | Brazil | Individual level 2×24 h recalls (Health Survey for São Paulo 2003–2007) | Brazilian Healthy Eating Index Revised | 9 food groups: fruits (total and whole), vegetables (total and dark green/orange vegetables and legumes), grains (total and whole), milk and dairy, meat and eggs and legumes, and oils 2 restricting nutrients: Na and saturated fat 1 other component: energy from solid fat, added sugar and alcohol | Total energy intake Nutrient intake Food group intake | / | GHGE |
| Vieux et al. (2013)( 37 ) | France | Individual level 7 d diet record (Individual National Survey and Food Consumption 2006–2007) | Energy density Mean Adequacy Ratio Mean Excess Ratio | Total energy and diet weight 20 key nutrients: protein, fibre, retinol equivalents, thiamin, riboflavin, niacin, vitamins B6, B12, C, E and D, Ca, K, Fe, Mg, Zn, Cu, iodine, Se 3 restricting nutrients: saturated fat, Na and free sugars Total energy intake Total diet weight | Total energy intake Total diet weight Nutrient intake | 391 items | GHGE |
| Masset et al. (2014)( 38 ) | France | Individual level 7 d diet record (Individual National Survey and Food Consumption 2006–2007) | PANDiet score | 20 key nutrients: protein, carbohydrate, fat, polyunsaturated fat, fibre, vitamins A, thiamin, niacin, B6, folic acid, B12, C, D and E, minerals Ca, Mg, Zn, P, K and Fe 3 restricting nutrients: saturated fat, cholesterol and Na | Total energy intake Total diet weight Food group intake | 391 items | GHGE‡ |
| Van Dooren et al. (2014)( 40 ) and Van Dooren and Aiking (2014)( 41 ) | Netherlands | Individual level 2 d diet record (Dutch National Food Consumption Survey 1998) | Health score | Total energy 2 key nutrients: total fat and fibre 5 restricting nutrients: total fat, saturated fat, trans-fat, free sugars and Na 3 food groups: vegetables, fruit and fish | Total energy intake Food group intake | 206 items | GHGE Land use§ |
| Monsivais et al. (2015)( 57 ) | UK | Individual level FFQ (130-item, semi-quantitative) | DASH (Dietary Approaches to Stop Hypertension) score | 7 food groups: fruits, vegetables, nuts and legumes, whole grains, low-fat dairy, red and processed meat, foods high in added sugar 1 restricting nutrient: Na | Total energy intake | 94 commodities | GHGE |
| Röös et al. (2015)( 39 ) | Sweden | Individual level 4 d diet record (Riskmaten 2012) | NRD (Nutrient-Rich Diet) 9.3 NRD 11.4 NRD 10.3 | 9 to 11 key nutrients: protein, fibre, vitamins A, C and E, Ca, Fe, Mg, K (11.4, plus vitamin D and folate; 10.3, plus vitamin D and folate/fibre) 3 or 4 restricting nutrients: SFA, added sugar, Na (11.4, plus P) | Total energy intake Nutrient intake | 90 items | Climate change Land use Biodiversity damage potential |
GHGE, greenhouse gas emissions.
Diet scores are used to subdivide the population into groups of nutritional quality (e.g. Vieux et al. ( 37 ), created four classes of nutritional quality in which a high-nutritional-quality diet was defined as having a Mean Adequacy Ratio score above the median, a Mean Excess Ratio score below the median and an Energy Density score below the median; Monsivais et al. ( 57 ), quintiles of DASH scores; Masset et al. ( 38 ), two groups by median split of PANDiet score). Diet scores are also used for comparison of different dietary scenarios (e.g. Carvalho et al. ( 51 ), moderate meat consumption pattern with excessive meat consumption patterns (having a red and processed meat intake higher than the World Cancer Research Fund maximum recommended intake of red and processed meat of 500 g/week (≈71·4 g/d)); Röös et al. ( 24 ), current diet with the Swedish Nordic recommended diet and the low-carbohydrate/high-fat diet applying energy-equivalent scenarios; Van Dooren et al. ( 40 ) and Van Dooren and Aiking( 41 ), current diet with recommended Dutch diet, semi-vegetarian, traditional vegetarian, vegan, Mediterranean, New Nordic Diet, historical Low Lands and optimised Low Lands diets).
Food aggregation level: the number of food items or commodities (depending on author’s terminology) for which environmental sustainability data of food intake was available.
GHGE median cut-off point to define a lower- v. a higher-carbon diet, and then in combination with the higher-quality diet (PANDiet above median) the more sustainable diet in this populations has been identified.
GHGE and land use are incorporated into a composite sustainability score that is used for the comparison of different dietary scenarios.