Environmental Impact of Dietary Choices: Role of the Mediterranean and Other Dietary Patterns in an Italian Cohort

Background: Current scientific literature suggests healthy dietary patterns may have less environmental impact than current consumption patterns, but most of the studies rely on theoretical modeling. The aim of this study was to assess the impact on resources (land, water, and energy) use and greenhouse gas (GHG) emissions of healthy dietary patterns in a sample of Italian adults. Methods: Participants (n = 1806) were recruited through random sampling in the city of Catania, southern Italy. Dietary consumption was assessed through a validated food frequency questionnaire (FFQ); dietary patterns were calculated through dietary scores. The specific environmental footprints of food item production/processing were obtained from various available life-cycle assessments; a sustainability score was created based on the impact of the four environmental components calculated. Results: The contribution of major food groups to the environmental footprint showed that animal products (dairy, egg, meat, and fish) represented more than half of the impact on GHG emissions and energy requirements; meat products were the stronger contributors to GHG emissions and water use, while dairy products to energy use, and cereals to land use. All patterns investigated, with the exception of the Dietary Approach to Stop Hypertension (DASH), were linearly associated with the sustainability score. Among the components, higher adherence to the Mediterranean diet and Alternate Diet Quality Index (AHEI) was associated with lower GHG emissions, dietary quality index-international (DQI-I) with land use, while Nordic diet with land and water use. Conclusions: In conclusion, the adoption of healthy dietary patterns involves less use of natural resources and GHG emissions, representing eco-friendlier options in Italian adults

Substitution Models ofWater for Other Beverages, and the Incidence of Obesity and Weight Gain in the SUN Cohort

Obesity is a major epidemic for developed countries in the 21st century. The main cause of obesity is energy imbalance, of which contributing factors include a sedentary lifestyle, epigenetic factors and excessive caloric intake through food and beverages. A high consumption of caloric beverages, such as alcoholic or sweetened drinks, may particularly contribute to weight gain, and lower satiety has been associated with the intake of liquid instead of solid calories. Our objective was to evaluate the association between the substitution of a serving per day of water for another beverage (or group of them) and the incidence of obesity and weight change in a Mediterranean cohort, using mathematical models. We followed 15,765 adults without obesity at baseline. The intake of 17 beverage items was assessed at baseline through a validated food-frequency questionnaire. The outcomes were average change in body weight in a four-year period and new-onset obesity and their association with the substitution of one serving per day of water for one of the other beverages. During the follow-up, 873 incident cases of obesity were identified. In substitution models, the consumption of water instead of beer or sugar-sweetened soda beverages was associated with a lower obesity incidence (the Odds Ratio (OR) 0.80 (95% confidence interval (CI) 0.68 to 0.94) and OR 0.85 (95% CI 0.75 to 0.97); respectively) and, in the case of beer, it was also associated with a higher average weight loss (weight change difference = 328 g; (95% CI 566 to 89)). Thus, this study found that replacing one sugar-sweetened soda beverage or beer with one serving of water per day at baseline was related to a lower incidence of obesity and to a higher weight loss over a four-year period time in the case of beer, based on mathematical models

Global sustainability (health, environment and monetary costs) of three dietary patterns: results from a Spanish cohort (the SUN project)

Objective To evaluate the sustainability of the dietary patterns, according to their effects on health and environment and their affordability. Design Prospective, ongoing cohort study of university graduates. Settings The Spanish SUN project (Seguimiento Universidad de Navarra, University of Navarra Follow-up), starting from 1999. Participants A total of 18 429 participants. Methods Information from participants is collected every 2 years by validated questionnaires. We assessed three dietary patterns (the Mediterranean, the Western and the Provegetarian dietary patterns). The rate advancement period (RAP) was used to assess the healthiness of each pattern (considering the composite endpoint of all-cause mortality, cardiovascular disease, breast cancer or type 2 diabetes). We also assessed environmental footprints and monetary costs of each dietary pattern. Results After a median follow-up of 10.1 years, we identified 469 incident cases of the composite endpoint. The Mediterranean dietary pattern exhibited the best RAP (3.10 years gained [95% CI 4.35 to 1.85] for the highest vs the lowest quartile), while the Western pattern was the unhealthiest pattern (1.33 years lost when comparing extreme quartiles). In a scale between 4 and 16 of harmful environmental effects (the lower, the more environmentally friendly), the Provegetarian pattern scored best (8.82 [95% CI 8.75 to 8.88] when comparing extreme quartiles), whereas the Western pattern was the most detrimental pattern (10.80 [95% CI 10.72 to 10.87]). Regarding monetary costs, the Western pattern was the most affordable pattern (€5.87/day [95%CI 5.82 to 5.93], for the upper quartile), while the Mediterranean pattern was the most expensive pattern (€7.52/day [95%CI 7.47 to 7.56]). The Mediterranean dietary pattern was the most overall sustainable option, closely followed by the Provegetarian pattern. The least overall sustainable pattern was the Western dietary pattern. Conclusion Following plant-based diets, like the Mediterranean or Provegetarian dietary patterns, could be a good option in order to achieve an overall sustainable diet

Global sustainability (health, environment and monetary costs) of three dietary patterns: results from a Spanish cohort (the SUN project)

Objective To evaluate the sustainability of the dietary patterns, according to their effects on health and environment and their affordability. Design Prospective, ongoing cohort study of university graduates. Settings The Spanish SUN project (Seguimiento Universidad de Navarra, University of Navarra Follow-up), starting from 1999. Participants A total of 18 429 participants. Methods Information from participants is collected every 2 years by validated questionnaires. We assessed three dietary patterns (the Mediterranean, the Western and the Provegetarian dietary patterns). The rate advancement period (RAP) was used to assess the healthiness of each pattern (considering the composite endpoint of all-cause mortality, cardiovascular disease, breast cancer or type 2 diabetes). We also assessed environmental footprints and monetary costs of each dietary pattern. Results After a median follow-up of 10.1 years, we identified 469 incident cases of the composite endpoint. The Mediterranean dietary pattern exhibited the best RAP (3.10 years gained [95% CI 4.35 to 1.85] for the highest vs the lowest quartile), while the Western pattern was the unhealthiest pattern (1.33 years lost when comparing extreme quartiles). In a scale between 4 and 16 of harmful environmental effects (the lower, the more environmentally friendly), the Provegetarian pattern scored best (8.82 [95% CI 8.75 to 8.88] when comparing extreme quartiles), whereas the Western pattern was the most detrimental pattern (10.80 [95% CI 10.72 to 10.87]). Regarding monetary costs, the Western pattern was the most affordable pattern (€5.87/day [95%CI 5.82 to 5.93], for the upper quartile), while the Mediterranean pattern was the most expensive pattern (€7.52/day [95%CI 7.47 to 7.56]). The Mediterranean dietary pattern was the most overall sustainable option, closely followed by the Provegetarian pattern. The least overall sustainable pattern was the Western dietary pattern. Conclusion Following plant-based diets, like the Mediterranean or Provegetarian dietary patterns, could be a good option in order to achieve an overall sustainable diet

Nutritional quality and health effects of low environmental impact diets: The "Seguimiento Universidad de Navarra" (SUN) Cohort

Current dietary patterns are negatively affecting both the environment and people’s health. Healthy diets are generally more environmentally friendly. However, few studies have focused on the health consequences of diets with low environmental impact. We analyzed differences in the dietary composition (types of food, macro- and micro-nutrients) of those diets with high and low environmental impact, according to greenhouse gas emission and resources use (water, land and energy) using data from a Spanish cohort (17,387 participants), collected by means of a validated food frequency questionnaire. Cox analyses were used to assess the association of dietary environmental impact with total mortality risk. At a given level of energy intake, diets with lower environmental impact contained higher amounts of plant-based foods and lower levels of animal-derived products. Less polluting diets involved higher amounts of polyunsaturated fats and dietary fiber and lower amounts of saturated fats and sodium. However, diets associated with less environmental damage also contained more added sugars, but lower levels of vitamin B12, zinc and calcium. We did not detect any association between dietary environmental impact and risk of mortality. Diets should not only produce minimal environmental impact, but the maximum overall benefits for all key dimensions encompassed in sustainable diets

Nutritional quality and health effects of low environmental impact diets: The "Seguimiento Universidad de Navarra" (SUN) Cohort

Current dietary patterns are negatively affecting both the environment and people’s health. Healthy diets are generally more environmentally friendly. However, few studies have focused on the health consequences of diets with low environmental impact. We analyzed differences in the dietary composition (types of food, macro- and micro-nutrients) of those diets with high and low environmental impact, according to greenhouse gas emission and resources use (water, land and energy) using data from a Spanish cohort (17,387 participants), collected by means of a validated food frequency questionnaire. Cox analyses were used to assess the association of dietary environmental impact with total mortality risk. At a given level of energy intake, diets with lower environmental impact contained higher amounts of plant-based foods and lower levels of animal-derived products. Less polluting diets involved higher amounts of polyunsaturated fats and dietary fiber and lower amounts of saturated fats and sodium. However, diets associated with less environmental damage also contained more added sugars, but lower levels of vitamin B12, zinc and calcium. We did not detect any association between dietary environmental impact and risk of mortality. Diets should not only produce minimal environmental impact, but the maximum overall benefits for all key dimensions encompassed in sustainable diets

Environmental Impact of Dietary Choices: Role of the Mediterranean and Other Dietary Patterns in an Italian Cohort

Background: Current scientific literature suggests healthy dietary patterns may have less environmental impact than current consumption patterns, but most of the studies rely on theoretical modeling. The aim of this study was to assess the impact on resources (land, water, and energy) use and greenhouse gas (GHG) emissions of healthy dietary patterns in a sample of Italian adults. Methods: Participants (n = 1806) were recruited through random sampling in the city of Catania, southern Italy. Dietary consumption was assessed through a validated food frequency questionnaire (FFQ); dietary patterns were calculated through dietary scores. The specific environmental footprints of food item production/processing were obtained from various available life-cycle assessments; a sustainability score was created based on the impact of the four environmental components calculated. Results: The contribution of major food groups to the environmental footprint showed that animal products (dairy, egg, meat, and fish) represented more than half of the impact on GHG emissions and energy requirements; meat products were the stronger contributors to GHG emissions and water use, while dairy products to energy use, and cereals to land use. All patterns investigated, with the exception of the Dietary Approach to Stop Hypertension (DASH), were linearly associated with the sustainability score. Among the components, higher adherence to the Mediterranean diet and Alternate Diet Quality Index (AHEI) was associated with lower GHG emissions, dietary quality index-international (DQI-I) with land use, while Nordic diet with land and water use. Conclusions: In conclusion, the adoption of healthy dietary patterns involves less use of natural resources and GHG emissions, representing eco-friendlier options in Italian adults

Substitution Models ofWater for Other Beverages, and the Incidence of Obesity and Weight Gain in the SUN Cohort

Obesity is a major epidemic for developed countries in the 21st century. The main cause of obesity is energy imbalance, of which contributing factors include a sedentary lifestyle, epigenetic factors and excessive caloric intake through food and beverages. A high consumption of caloric beverages, such as alcoholic or sweetened drinks, may particularly contribute to weight gain, and lower satiety has been associated with the intake of liquid instead of solid calories. Our objective was to evaluate the association between the substitution of a serving per day of water for another beverage (or group of them) and the incidence of obesity and weight change in a Mediterranean cohort, using mathematical models. We followed 15,765 adults without obesity at baseline. The intake of 17 beverage items was assessed at baseline through a validated food-frequency questionnaire. The outcomes were average change in body weight in a four-year period and new-onset obesity and their association with the substitution of one serving per day of water for one of the other beverages. During the follow-up, 873 incident cases of obesity were identified. In substitution models, the consumption of water instead of beer or sugar-sweetened soda beverages was associated with a lower obesity incidence (the Odds Ratio (OR) 0.80 (95% confidence interval (CI) 0.68 to 0.94) and OR 0.85 (95% CI 0.75 to 0.97); respectively) and, in the case of beer, it was also associated with a higher average weight loss (weight change difference = 328 g; (95% CI 566 to 89)). Thus, this study found that replacing one sugar-sweetened soda beverage or beer with one serving of water per day at baseline was related to a lower incidence of obesity and to a higher weight loss over a four-year period time in the case of beer, based on mathematical models

Low dietary magnesium and overweight/obesity in a Mediterranean population: a detrimental synergy for the development of hypertension. The SUN Project

Hypertension is the strongest independent modifiable risk factor for cardiovascular disease. We aimed to investigate the association of magnesium intake with incident hypertension in a Mediterranean population, and the potential modification of this association by body mass index (BMI). We assessed 14,057 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (67.0% women) initially free of hypertension. At baseline, a validated 136-item food frequency questionnaire was administered. We used Cox models adjusted for multiple socio-demographic, anthropometric, and lifestyle factors, and prevalent conditions present at baseline. Among a mean 9.6 years of follow-up we observed 1406 incident cases of medically diagnosed hypertension. An inverse association in multivariable-adjusted models was observed for progressively higher magnesium intake up to 500 mg/d vs. intake 27 kg/m(2). Lean participants with magnesium intake 200 mg/d also had a higher risk of incident hypertension. Adherence to the Mediterranean diet did not modify these associations. In conclusion, dietary magnesium intake < 200 mg/d was independently associated with a higher risk of developing hypertension in a Mediterranean cohort, stronger for overweight/obese participants. Our results emphasize the importance of encouraging the consumption of magnesium-rich foods (vegetables, nuts, whole cereals, legumes) in order to prevent hypertension