Are our diets getting healthier and more sustainable? Insights from the European Prospective Investigation into Cancer and Nutrition – Netherlands (EPIC-NL) cohort

Biesbroek, Sander; Boer, Jolanda M. A.; Schouw, Yvonne T. van der; Sluijs, Ivonne; Temme, Elisabeth H. M.

doi:10.1017/s1368980019001824

Cited by 14 publications

(7 citation statements)

References 29 publications

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“…Strong product and process innovation, improving nutritional profiles (e.g., reformulation, fortification, supplementation) and environmental performance is needed to meet the 2050 GHGE target in terms of healthy and acceptable diets, taking into account price, texture, and taste. Current dietary patterns in the Netherlands are not consistent with the required GHGE targets, and specific policies may be needed to help people shift to diets with lower environmental impacts ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

Future-proof and sustainable healthy diets based on current eating patterns in the Netherlands

Broekema

Tyszler

Veer

et al. 2020

The American Journal of Clinical Nutrition

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Background To keep global warming <1.5°C as recommended by the Intergovernmental Panel on Climate Change (IPCC), eating patterns must change. However, future diets should be modeled at a national level and respect cultural acceptability. Objectives We aimed to identify diets among Dutch adults satisfying nutritional and selected environmental requirements while deviating minimally from the baseline diet among Dutch adults. Methods We calculated per capita food system greenhouse gas emission (GHGE) targets derived from the IPCC 1.5-degree assessment study. Using individual adult dietary intake from the National Food Consumption Survey in the Netherlands (2007–2010) to form a baseline, we used quadratic optimization to generate diets that followed the baseline Dutch diet as closely as possible, while satisfying nutritional goals and remaining below GHGE targets. We considered 12 scenarios in which we varied GHGE targets [2050: 1.11 kg of carbon dioxide equivalent (kg CO2-eq) per person per day (pppd); 2030: 2.04 kg CO2-eq pppd; less strict 2030: 2.5 kg CO2-eq pppd; no target], modeled eating patterns (food-based dietary guidelines; flexitarian; pescatarian; lacto-ovo-vegetarian; vegan), and conducted exploratory analyses (food diversity; acceptability; food chain interdependency). Results Optimized solutions for 2030 required major decreases (<33% of baseline values) in consumption of beef, pork, cheese, snacks, and butter and increased consumption (>150% of baseline values) of legumes, fish and shellfish, peanuts, tree nuts, vegetables, soy foods, and soy drink. Eight food groups were within 33%–150% of the baseline diet among Dutch adults. The optimized solution complying to the lowest GHGE target (2050) lacked food diversity, and the (lacto-ovo) vegetarian and vegan optimized diets were prone to nutritional inadequacies. Conclusions Within Dutch eating habits, satisfying optimization constraints required a shift away from beef, cheese, butter, and snacks toward plant-based foods and fish and shellfish, questioning acceptability. Satisfying 2050 food system GHGE targets will require research in consumer preferences and breakthrough innovations in food production and processing.

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Section: Discussionmentioning

confidence: 99%

Future-proof and sustainable healthy diets based on current eating patterns in the Netherlands

Broekema

Tyszler

Veer

et al. 2020

The American Journal of Clinical Nutrition

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“…However, a previous study in EPIC-NL showed dietary changes between 6 baseline and 20 years follow-up to be relatively modest. 43 Finally, the current study used the 7 Dutch LCA Database to calculate environmental indicators. It should be noted that, although 8 the LCA database is a comprehensive source of LCA indicators, there is also some 9 uncertainty in the data since they are modelled and not actually measured.…”

Section: Table 4 Descriptive Statistics Of the Environmental Impact Indicators By Quartiles Of Thementioning

confidence: 99%

Adherence to the EAT-Lancet Healthy Reference Diet in relation to Coronary Heart Disease, All-Cause Mortality Risk and Environmental Impact: Results from the EPIC-NL Cohort

Colizzi

Harbers

Vellinga

et al. 2021

Preprint

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Objectives: To construct a diet-score measuring the level of adherence to the Healthy Reference Diet (HRD), to explore whether adherence to the HRD is associated with coronary heart disease (CHD), all-cause mortality risk, and to calculate its environmental impact. Design: Prospective cohort study. Setting: The Dutch contribution to the European Prospective Investigation into Cancer and Nutrition (EPIC-NL). Participants: 37,349 adults (20-70y) without CHD at baseline. Main outcome measures: Primary outcomes were incident CHD and all-cause mortality. Secondary outcomes were greenhouse gas emission (GHGE), land use, blue water use, freshwater eutrophication, marine eutrophication, and terrestrial acidification. Results: During a median 15.3-year follow-up, 2,543 cases of CHD occurred, and 5,648 individuals died from all causes. The average HRD-score was 73 (SD=10). High adherence to the HRD was associated with a 15% lower risk of CHD (hazard ratio 0.85, 95% confidence interval 0.75 to 0.96), as well as a 17% lower risk of all-cause mortality (hazard ratio 0.83, 95% confidence interval 0.77 to 0.90) in multivariable-adjusted models. Better adherence to the HRD was associated with lower environmental impact from GHGE (β= -0.10 kg CO2-eq, 95% confidence interval -0.13 to -0.07), land use (β= -0.11 m2 per year, 95% confidence interval -0.12 to -0.09), freshwater eutrophication (β= -0.000002 kg P-eq, 95% confidence interval -0.000004 to -0.000001), marine eutrophication (β= -0.00035 kg N-eq, 95% confidence interval -0.00042 to -0.00029), and terrestrial acidification (β = -0.004 kg SO2-eq, 95% confidence interval -0.004 to -0.003), but with higher environmental impact from blue water use (β=0.044 m3, 95% confidence interval 0.043 to 0.045). Conclusion: High adherence to the HRD was associated with lower risk of CHD and all-cause mortality. Additionally, increasing adherence to the HRD could lower some aspects of the environmental impact of diets, but attention is needed for the associated increase in blue water use.

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“…However, a previous study in EPIC‐NL showed dietary changes between baseline and 20‐year follow‐up to be relatively modest. 61 Nevertheless, although the mean intakes of diet may have not changed substantially, individual variation could still be substantial and lead to attenuation of associations. With regard to our analyses, we need to address the possibility of residual confounding.…”

Section: Discussionmentioning

confidence: 99%

Adherence to the EAT‐Lancet Healthy Reference Diet in Relation to Risk of Cardiovascular Events and Environmental Impact: Results From the EPIC‐NL Cohort

Colizzi

Harbers

Vellinga

et al. 2023

JAHA

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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.

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Are our diets getting healthier and more sustainable? Insights from the European Prospective Investigation into Cancer and Nutrition – Netherlands (EPIC-NL) cohort

Cited by 14 publications

References 29 publications

Future-proof and sustainable healthy diets based on current eating patterns in the Netherlands

Future-proof and sustainable healthy diets based on current eating patterns in the Netherlands

Adherence to the EAT-Lancet Healthy Reference Diet in relation to Coronary Heart Disease, All-Cause Mortality Risk and Environmental Impact: Results from the EPIC-NL Cohort

Adherence to the EAT‐Lancet Healthy Reference Diet in Relation to Risk of Cardiovascular Events and Environmental Impact: Results From the EPIC‐NL Cohort

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