Food consumption patterns affect the environment as well as public health, and monitoring is needed. The aim of this study was to evaluate the Dutch food consumption patterns for environmental (greenhouse gas (GHG) emissions and blue water use) and health aspects (Dutch Healthy Diet index 2015), according to age, gender, and consumption moments. Food consumption data for 4313 Dutch participants aged 1 to 79 years were assessed in 2012 to 2016, by two non-consecutive 24-h recalls. The environmental impact of foods was quantified using a life cycle assessment for, e.g., indicators of GHG emissions and blue water use. The healthiness of diet, operationalized by the Dutch Healthy Diet index 2015, was assessed for 2078 adults aged ≥19 years. The average daily diet in the Netherlands was associated with 5.0 ± 2.0 kg CO2-equivalents of GHG emissions and 0.14 ± 0.08 m3 of blue water use. Meat, dairy and non-alcoholic beverages contributed most to GHG emissions, and non-alcoholic beverages, fruits, and meat to blue water use. More healthy diets were associated with a lower GHG emission and higher blue water use. Different associations of environmental indicators (GHG emissions and blue water use) with health aspects of diets need to be considered when aligning diets for health and sustainability.

Objective: To investigate the effects of a sugar-sweetened beverage (SSB) tax and a nutrient profiling tax on consumer food purchases in a virtual supermarket. Design: A randomised controlled trial was conducted with a control condition with regular food prices (n 152), an SSB tax condition (n 130) and a nutrient profiling tax condition based on Nutri-Score (n 112). Participants completed a weekly grocery shop for their household. Primary outcome measures were SSB purchases (ordinal variable) and the overall healthiness of the total shopping basket (proportion of total unit food items classified as healthy). The secondary outcome measure was the energy (kcal) content of the total shopping basket. Data were analysed using regression analyses. Setting: Three-dimensional virtual supermarket. Participants: Dutch adults aged ≥18 years are being responsible for grocery shopping in their household (n 394). Results: The SSB tax (OR = 1·62, (95 % CI 1·03, 2·54)) and the nutrient profiling tax (OR = 1·88, (95 %CI 1·17, 3·02)) increased the likelihood of being in a lower-level category of SSB purchases. The overall healthiness of the total shopping basket was higher (+2·7 percent point, (95 % CI 0·1, 5·3)), and the energy content was lower (−3301 kcal, (95 % CI −6425, −177)) for participants in the nutrient profiling tax condition than for those in the control condition. The SSB tax did not affect the overall healthiness and energy content of the total shopping basket (P > 0·05). Conclusions: A nutrient profiling tax targeting a wide range of foods and beverages with a low nutritional quality seems to have larger beneficial effects on consumer food purchases than taxation of SSB alone.

Background: The current food system has major consequences for the environment and for human health. Alignment of the food policy areas of mitigating climate change and public health will ensure coherent and effective policy interventions for sustaining human health and the environment. This paper explores literature on demand-side policies that aim to reduce consumption of animal-based foods, increase plant-based foods, and reduce overconsumption. Methods: We searched for publications, published between January 2000 and December 2019, considering the above policy domains. Articles were distinguished for type of policy instrument, for topic via keywords and examples were given. Results: The majority of demand-side policies focus on preventing overweight and obesity, using all types of policy instruments including more forceful market-based policies. Hardly any examples of public policies explicitly aiming to lower animal-based foods consumption were found. Policies combining health and sustainability objectives are few and mainly of the information type. Discussion: Moving towards environmentally sustainable and healthy diets is challenging as the implemented demand-side policies focus largely on human health, and not yet on environmental outcomes, or on win-wins. Policies targeting foods from the health perspective can contribute to lower environmental impacts, by indicating suitable animal-based food replacers, and aiming at avoiding overconsumption of energy dense-nutrient poor foods. Preferred policies include a variety of instruments, including strong measures. Conclusions: Working solutions are available to ensure coherent and effective demand side food policies aligning public health and environmental aims. Implementation of aligned and effective policy packages is urgent and needed.

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 (HR Q4vsQ1 , 0.88 [95% CI, 0.78–1.00]), and total stroke (HR Q4vsQ1 , 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.

Background Reduced meat consumption benefits human and planetary health. Modelling studies have demonstrated the significant health and environmental gains that could be achieved through fiscal measures targeting meat. Adding other interventions may enhance the effect of a fiscal measure. The current study aimed to examine the effect of higher meat prices, an information nudge and a combination of both measures on meat purchases in a three-dimensional virtual supermarket. Methods A parallel designed randomised controlled trial with four conditions was performed. Participants (≥ 18 years) were randomly assigned to the control condition or one of the experimental conditions: a 30% price increase for meat (‘Price condition’), an information nudge about the environmental impact of meat production and consumers’ role in that regard (‘Information nudge condition’) or a combination of both (‘Combination condition’). Participants were asked to shop for their household for one week. The primary outcome was the difference in the total amount of meat purchased in grams per household per week. Results Between 22 June 2020 and 28 August 2020, participants were recruited and randomly assigned to the control and experimental conditions. The final sample included 533 participants. In the ‘Combination condition’, − 386 g (95% CI: − 579, − 193) meat was purchased compared with the ‘Control condition’. Compared to the ‘Control condition’ less meat was purchased in the ‘Price condition’ (− 144 g (95%CI: − 331, 43)), although not statistically significant, whereas a similar amount of meat was purchased in the ‘Information nudge condition’ (1 g (95%CI: − 188, 189)). Conclusion Achieving the most pronounced effects on reduced meat purchases will require a policy mixture of pricing and informational nudging. Less meat is purchased in a virtual supermarket after raising the meat price by 30% combined with an information nudge. The results could be used to design evidence-based policy measures to reduce meat purchases. Trial registration The trial was registered in the Netherlands Trial Register identifier NL8628. Registered on 18/05/2020. ICTRP Search Portal (who.int) NTR (trialregister.nl).