Towards healthy and environmentally sustainable diets for European consumers

Poor diet is a leading risk for non-communicable diseases, but adherence to food-based dietary guidelines in Europe is low. In addition, our current diet has a major impact on the environment. There is thus an urgent need to improve the diets for European consumers. This thesis shows and evaluates possible solutions for improved diets using a benchmarking diet model. The great advantage of this model is that it implicitly incorporates dietary preferences of consumers by making use of existing diets. Within the ranges of observed dietary practices, results show that consumers may improve their nutrient quality up to 16% and reduce their diet-related greenhouse gas emissions up to 20%. However, to simultaneously achieve these improvements, dietary preferences need to be inspired by the rich diversity of European diets and complementary changes in the food supply chain are needed

Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study

Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study (CI) 0.66, 0.99], and stroke (HR 0.61; 95% CI 0.42, 0.88) incidence, but not with CHD after an average of 16.6 year follow-up, and with diastolic blood pressure, after 12 year follow-up. The AHEI-2010 was inversely associated with stroke (HR 0.66; 95% CI 0.42, 0.88) incidence, aortic pulse wave velocity, and C-reactive protein. The HDI was not associated with any single outcome. Conclusions: Higher DASH and AHEI-2010 scores were associated with lower CVD and stroke risk, and favourable cardiovascular health outcomes, suggesting that encouraging middle-aged men to comply with the dietary recommendations for a healthy diet may have important implications for future vascular disease and population health

Dietary choices and environmental impact in four European countries

Effective food policies in Europe require insight into the environmental impact of consumers’ diet to contribute to global nutrition security in an environmentally sustainable way. The present study therefore aimed to assess the environmental impact associated with dietary intake across four European countries, and to explain sources of variations in environmental impact by energy intake, demographics and diet composition. Individual-level dietary intake data were obtained from nationally-representative dietary surveys, by using two non-consecutive days of a 24-h recall or a diet record, from Denmark (DK, n = 1710), Czech Republic (CZ, n = 1666), Italy (IT, n = 2184), and France (FR, n = 2246). Dietary intake data were linked to a newly developed pan-European environmental sustainability indicator database that contains greenhouse gas emissions (GHGE) and land use (LU) values for ∼900 foods. To explain the variation in environmental impact of diets, multilevel regression models with random intercept and random slopes were fitted according to two levels: adults (level 1, n = 7806) and country (level 2, n = 4). In the models, diet-related GHGE or LU was the dependent variable, and the parameter of interest, i.e. either total energy intake or demographics or food groups, the exploratory variables. A 200-kcal higher total energy intake was associated with a 9% and a 10% higher daily GHGE and LU. Expressed per 2000 kcal, mean GHGE ranged from 4.4 (CZ) to 6.3 kgCO2eq/2000 kcal (FR), and LU ranged from 5.7 (CZ) to 8.0 m2*year/2000 kcal (FR). Dietary choices explained most of the variation between countries. A 5 energy percent (50 g/2000 kcal) higher meat intake was associated with a 10% and a 14% higher GHGE and LU density, with ruminant meat being the main contributor to environmental footprints. In conclusion, intake of energy, total meat and the proportion of ruminant meat explained most of the variation in GHGE and LU of European diets. Contributions of food groups to environmental footprints however varied between countries, suggesting that cultural preferences play an important role in environmental footprints of consumers. In particular, Findings from the present study will be relevant for national-specific food policy measures towards a more environmentally-friendly diet.</p

Geographic and socioeconomic diversity of food and nutrient intakes: a comparison of four European countries

Purpose: Public health policies and actions increasingly acknowledge the climate burden of food consumption. The aim of this study is to describe dietary intakes across four European countries, as baseline for further research towards healthier and environmentally-friendlier diets for Europe. Methods: Individual-level dietary intake data in adults were obtained from nationally-representative surveys from Denmark and France using a 7-day diet record, Italy using a 3-day diet record, and Czech Republic using two replicates of a 24-h recall. Energy-standardised food and nutrient intakes were calculated for each subject from the mean of two randomly selected days. Results: There was clear geographical variability, with a between-country range for mean fruit intake from 118 to 199 g/day, for vegetables from 95 to 239 g/day, for fish from 12 to 45 g/day, for dairy from 129 to 302 g/day, for sweet beverages from 48 to 224 ml/day, and for alcohol from 8 to 15 g/day, with higher intakes in Italy for fruit, vegetables and fish, and in Denmark for dairy, sweet beverages and alcohol. In all countries, intakes were low for legumes ( 80 g/day). Within countries, food intakes also varied by socio-economic factors such as age, gender, and educational level, but less pronounced by anthropometric factors such as overweight status. For nutrients, intakes were low for dietary fibre (15.8–19.4 g/day) and vitamin D (2.4–3.0 µg/day) in all countries, for potassium (2288–2938 mg/day) and magnesium (268–285 mg/day) except in Denmark, for vitamin E in Denmark (6.7 mg/day), and for folate in Czech Republic (212 µg/day). Conclusions: There is considerable variation in food and nutrient intakes across Europe, not only between, but also within countries. Individual-level dietary data provide insight into the heterogeneity of dietary habits beyond per capita food supply data, and this is crucial to balancing healthy and environmentally-friendly diets for European citizens

Unravelling data for rapid evidence-based response to COVID-19: a summary of the unCoVer protocol

Introduction unCoVer - Unravelling data for rapid evidence-based response to COVID-19 - is a Horizon 2020-funded network of 29 partners from 18 countries capable of collecting and using real-world data (RWD) derived from the response and provision of care to patients with COVID-19 by health systems across Europe and elsewhere. unCoVer aims to exploit the full potential of this information to rapidly address clinical and epidemiological research questions arising from the evolving pandemic. Methods and analysis From the onset of the COVID-19 pandemic, partners are gathering RWD from electronic health records currently including information from over 22 000 hospitalised patients with COVID-19, and national surveillance and screening data, and registries with over 1 900 000 COVID-19 cases across Europe, with continuous updates. These heterogeneous datasets will be described, harmonised and integrated into a multi-user data repository operated through Opal-DataSHIELD, an interoperable open-source server application. Federated data analyses, without sharing or disclosing any individual-level data, will be performed with the objective to reveal patients' baseline characteristics, biomarkers, determinants of COVID-19 prognosis, safety and effectiveness of treatments, and potential strategies against COVID-19, as well as epidemiological patterns. These analyses will complement evidence from efficacy/safety clinical trials, where vulnerable, more complex/heterogeneous populations and those most at risk of severe COVID-19 are often excluded. Ethics and dissemination After strict ethical considerations, databases will be available through a federated data analysis platform that allows processing of available COVID-19 RWD without disclosing identification information to analysts and limiting output to data aggregates. Dissemination of unCoVer's activities will be related to the access and use of dissimilar RWD, as well as the results generated by the pooled analyses. Dissemination will include training and educational activities, scientific publications and conference communications.info:eu-repo/semantics/publishedVersio

The future burden of type 2 diabetes in Belgium: a microsimulation model

Objective: To forecast the annual burden of type 2 diabetes and related socio-demographic disparities in Belgium until 2030. Methods: This study utilized a discrete-event transition microsimulation model. A synthetic population was created using 2018 national register data of the Belgian population aged 0-80 years, along with the national representative prevalence of diabetes risk factors obtained from the latest (2018) Belgian Health Interview and Examination Surveys using Multiple Imputation by Chained Equations (MICE) as inputs to the Simulation of Synthetic Complex Data (simPop) model. Mortality information was obtained from the Belgian vital statistics and used to calculate annual death probabilities. From 2018 to 2030, synthetic individuals transitioned annually from health to death, with or without developing type 2 diabetes, as predicted by the Finnish Diabetes Risk Score, and risk factors were updated via strata-specific transition probabilities. Results: A total of 6722 [95% UI 3421, 11,583] new cases of type 2 diabetes per 100,000 inhabitants are expected between 2018 and 2030 in Belgium, representing a 32.8% and 19.3% increase in T2D prevalence rate and DALYs rate, respectively. While T2D burden remained highest for lower-education subgroups across all three Belgian regions, the highest increases in incidence and prevalence rates by 2030 are observed for women in general, and particularly among Flemish women reporting higher-education levels with a 114.5% and 44.6% increase in prevalence and DALYs rates, respectively. Existing age- and education-related inequalities will remain apparent in 2030 across all three regions. Conclusions: The projected increase in the burden of T2D in Belgium highlights the urgent need for primary and secondary preventive strategies. While emphasis should be placed on the lower-education groups, it is also crucial to reinforce strategies for people of higher socioeconomic status as the burden of T2D is expected to increase significantly in this population segment.This research was supported by the Research Foundation of Flanders (FWO) grant agreement G0C2520N.S

Lifestyle predictors of colorectal cancer in European populations : a systematic review

Abstract: BackgroundColorectal cancer (CRC) is the second most prevalent cancer in Europe, with one-fifth of cases attributable to unhealthy lifestyles. Risk prediction models for quantifying CRC risk and identifying high-risk groups have been developed or validated across European populations, some considering lifestyle as a predictor.PurposeTo identify lifestyle predictors considered in existing risk prediction models applicable for European populations and characterise their corresponding parameter values for an improved understanding of their relative contribution to prediction across different models.MethodsA systematic review was conducted in PubMed and Web of Science from January 2000 to August 2021. Risk prediction models were included if (1) developed and/or validated in an adult asymptomatic European population, (2) based on non-invasively measured predictors and (3) reported mean estimates and uncertainty for predictors included. To facilitate comparison, model-specific lifestyle predictors were visualised using forest plots.ResultsA total of 21 risk prediction models for CRC (reported in 16 studies) were eligible, of which 11 were validated in a European adult population but developed elsewhere, mostly USA. All models but two reported at least one lifestyle factor as predictor. Of the lifestyle factors, the most common predictors were body mass index (BMI) and smoking (each present in 13 models), followed by alcohol (11), and physical activity (7), while diet-related factors were less considered with the most commonly present meat (9), vegetables (5) or dairy (2). The independent predictive contribution was generally greater when they were collected with greater detail, although a noticeable variation in effect size estimates for BMI, smoking and alcohol.ConclusionsEarly identification of high-risk groups based on lifestyle data offers the potential to encourage participation in lifestyle change and screening programmes, hence reduce CRC burden. We propose the commonly shared lifestyle predictors to be further used in public health prediction modelling for improved uptake of the model

Operationalising the health aspects of sustainable diets : a review

Objective: Shifting towards a more sustainable food consumption pattern is an important strategy to mitigate climate change. In the past decade, various studies have optimised environmentally sustainable diets using different methodological approaches. The aim of the present review was to categorise and summarise the different approaches to operationalise the health aspects of environmentally sustainable diets. Design: Conventional keyword and reference searches were conducted in PubMed, Scopus, Web of Knowledge and CAB Abstracts. Inclusion criteria were: (i) English-language publication; (ii) published between 2005 and October 2015; (iii) dietary data collected for the diet as a whole at the national, household or individual level; (iv) comparison of the current diet with dietary scenarios; and (v) for results to consider the health aspect in some way. Setting: Consumer diets. Subjects: Adult population. Results: We reviewed forty-nine studies that combined the health and environmental aspects of consumer diets. Hereby, five approaches to operationalise the health aspect of the diet were identified: (i) food item replacements; (ii) dietary guidelines; (iii) dietary quality scores; (iv) diet modelling techniques; and (v) diet-related health impact analysis. Conclusions: Although the sustainability concept is increasingly popular and widely advocated by nutritional and environmental scientists, the journey towards designing sustainable diets for consumers has only just begun. In the context of operationalising the health aspects, diet modelling might be considered the preferred approach since it captures the complexity of the diet as a whole. For the future, we propose SHARP diets: environmentally Sustainable (S), Healthy (H), Affordable (A), Reliable (R) and Preferred from the consumer’s perspective (P).</p

SHARP-Indicators Database towards a public database for environmental sustainability

To initiate the achievement of an European-wide applicable public database for indicators of environmental sustainability of the diet, we developed the SHARP Indicators Database (SHARP-ID). A comprehensive description of the development of the SHARP-ID is provided in this article. In the SHARP-ID, environmental impact assessment was based on attributional life cycle analyses using environmental indicators greenhouse gas emission (GHGE) and land use (LU). Life cycle inventory data of 182 primary products were combined with data on production, trade and transport, and adjusted for consumption amount using conversions factors for production, edible portion, cooking losses and gains, and for food losses and waste in order to derive estimates of GHGE and LU for the foods as eaten. Extrapolations based on similarities in type of food, production system and ingredient composition were made to obtain estimates of GHGE and LU per kg of food as eaten for 944 food items coded with a unique FoodEx2-code of EFSA and consumed in four European countries, i.e. Denmark, Czech Republic, Italy and France. This LCA-food-item database can be linked to food intake data collected at the individual level in order to calculate the environmental impact of individual's diets. The application of this database to European survey data is described in an original research article entitled “Dietary choices and environmental impact in four European countries” (Mertens et al., 2019).</p