Perspective: Modeling Healthy Eating Patterns for Food-Based Dietary Guidelines—Scientific Concepts, Methodological Processes, Limitations, and Lessons

Abstract

The relations between dietary features and human health are varied and complex. Health-related variables are many and they have intricate relations at different and interrelated nutritional levels: nutrients, food groups, and the complex overall pattern. Food-based dietary guidelines (FBDGs) are principally designed to synthesize this information to make it available to the public. Here, we describe the method used to establish healthy eating patterns (HEPs) for the latest French FBDGs, which consists of in-depth food pattern modeling using an enhanced optimization method that gathered all aspects of HEPs. We present the novelty of this food modeling approach for FBDGs, which aims to gather information related to nutrients, food contaminants, and epidemiological relations with long-term health, and to be combined with the objective of realistic dietary patterns that deviate minimally from the prevailing diet. We draw lessons from stepwise implementation of the method and discuss its strengths, limitations, and perspectives. In light of the modeled HEPs, we discuss the importance of food grouping; of accounting for dietary habits while not precluding modeled diets that can be realistic/acceptable; and of taking into account the exposure to food contaminants. We discuss the tolerance and flexibility to be applied to certain dietary reference values for nutrients and health-based guidance values for contaminants so that HEPs can ultimately be identified, and how account can be taken of varied health-related outcomes applied to food groups. Although the approach involves all the peculiar uncertainties of numerous optimization model parameters and input data, its merit is that it offers a rationalized approach to establishing HEPs with multiple constraints and competing objectives. It is also versatile because it is possible to operationalize further dimensions of dietary patterns to favor human and planetary health.

Addressing nutrient shortfalls in 1- to 5-year-old Irish children using diet modeling: development of a protocol for use in country-specific population health

“…Many different approaches for developing FBDGs exist, such as single-or multiobjective optimization modeling, food pattern modeling, and a combination of these (51). In the current study, nutrient shortfalls were addressed by developing FBDGs in the context of energy requirements related to body size.…”

Plant to animal protein ratio in the diet: nutrient adequacy, long-term health and environmental pressure

“…We modeled diets according to changes in intakes of food groups, based on the present food repertoire and current intake levels in the population. Food grouping is critical in diet modeling (31), and food diversity and composition can change rapidly in western countries, as seen by recent changes (67). A similar limitation applies to the assessment of a diet’s environmental impacts, for which also we did not consider variations related to food production systems (68, 69).…”

“…In our study, the HR criterion was thus expressed and minimized as: Where i denotes the food groups to be decreased (red meat, processed meat and sweetened beverages), j denotes the food groups to be increased (whole grain products, fruits, vegetables, legumes, nuts and seeds, and milk), Opt(i) and Opt(j) are the optimized consumptions of food groups i and j, respectively (in g/d), Max(i) is the upper limit of consumption of food group i (in g/d), TMREL(j) is the TMREL value of food group j (in g/d), DALYs(i) and DALYs(j) are the disability-adjusted life-years associated with excessive or insufficient consumptions of food groups i and j, respectively (in y), and DALYs(all) is the sum of all DALYs(i) and DALYs(j). The Max values used were the maximal recommended consumption of unhealthy foods in line with the French dietary guidelines (31): 71g/d for red meat, 25g/d for processed meat and 263 g/d (corresponding to the average portion size) for sweetened beverages intake. The TMREL and DALYs values used were issued from the most recent (2019) estimates from the GBD (30) adapted to our study context (by using sex-specific and French DALYs values, Supplemental Table 2).…”

“…Thirty-five nutritional constraints were applied to ensure adequate nutrient intake in the male and female populations (Supplemental Table 3), based on the most recent reference values from the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) (32). We did not consider any constraints for vitamin D, because its reference value is known to be much too high to be reached by a non-fortified diet alone (29,31). As the absorption of iron and zinc is dependent on dietary factors, the requirements were based on bioavailable iron and zinc calculated from the dietary intake using equations that predict their absorption (33)(34)(35), as detailed in a previous study by our group (29).…”

Considerations for the translation of nutrient recommendations as dietary plans for infants, children, and adolescents as reported in Italian Guidelines for healthy eating

“…This process was more recently and concisely described by the European Food Safety Authority (EFSA) ( 6 ). The translation of nutrient population goals into food-based dietary guidelines is a complex process that must combine scientific findings from nutrition research with practical components related to food behaviors and preferences ( 7 ). For that, the development of DGs requires the synthesis and analysis of a wide range of evidence and contextual information; the process also requires the involvement of multiple stakeholders from relevant sectors and could have both technical and political components ( 8 , 9 ).…”