7 research outputs found

    Adapting the Eat-Lancet Healthy Reference Diet to Cambodia: Understanding Dietary Intake, Perceptions of Environmental Challenges, and Environmental Impacts of Diets

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    Background: Global food systems are being called upon to deliver healthier and more sustainable diets. Few studies have explored shifts to a healthy and sustainable diet or evaluated dietary impacts on multiple environmental systems in low- and middle-income countries (LMIC). Objective: This study sought to develop a framework for adapting a global healthy and sustainable diet, the EAT-Lancet Healthy Reference Diet (HRD), to the context of Cambodia by exploring perceptions of the relevance of environmental challenges for the Cambodian food system, exploring current diets, and analyzing environmental footprints of Cambodian diets and of the HRD. Methods: In the absence of quantitative dietary data for Cambodia, this dissertation estimates daily individual intake based on data from FAO Food Balance Sheets (FBS) 2016-19, the Cambodia Living Standards Measurement Study Plus (LSMS) 2019-20, the Global Dietary Database (GDD) 2018, the Global Burden of Disease (GBD) 2019, and the Dietary Quality Questionnaire (DQQ) 2021. Average individual daily consumption and prevalence of food group consumption were calculated and compared to the HRD mean recommended intake and food group ranges. Semi-structured interviews with food system experts (n=15) were conducted to elicit perceptions of Cambodian food systems' environmental challenges. The planetary boundaries framework was used to rank which of the five environmental dimensions were perceived to be under most stress. To estimate the environmental impacts of diets, this study adapted the World Wildlife Fund (WWF) Planet-Based Diets environmental impacts model for greenhouse gas emissions (GHGe), freshwater consumption, land use, and biodiversity loss. Three baseline daily intakes were used based on data from FBS, LSMS, and GDD. Environmental impacts intensities were calculated by food group and applied to baseline diets and the HRD. Impact of individual yearly diets were compared to food systems 2050 targets downscaled from the global to the individual level. Results: There is agreement across data sources on the low consumption of vegetables, fruit, legumes, nuts, and whole grains compared to the HRD recommendations. Results show animal-source food consumption is within HRD recommended ranges except for pork, with animal-source food estimated at 17 to 33 g/person/day compared to the recommended 0-14 g/person/day. Consumption of vegetable protein sources (beans, soy foods, nuts) is low, ranging from 5 to 31 g/person/day across data sources compared to a mean recommendation of 125 g/person/day. Environmental challenges across five environmental systems were described as impacting the Cambodian food system. Participants ranked climate change as the most concerning area, with freshwater systems and land use change tied as second and biodiversity loss as the third most concerning dimension. Participants perceived environmental challenges to have cascading adverse impacts across all areas of the food system. A dietary shift from baseline Cambodian diets to the HRD is associated with a 12.9-34.1% reduction in GHGe, 10.4-29.9% reduction in land use, 5.1-19% reduction in freshwater consumption, and a 0.3-20.1% reduction in biodiversity loss, depending on the data source used to estimate the baseline diet. Nonetheless, HRD footprint continue to surpass 2050 food system targets for GHGe and land use. Conclusions: This study emphasize the importance of environmental sustainability for Cambodian food systems and the potential for dietary changes to play a positive role in natural resource conservation. While Cambodian diets have low environmental impacts relative to other countries, the HRD offers a roadmap for further reducing the national food consumption footprint on four environmental systems. However, differences in estimated food intakes can lead to distinct interpretations of human and planetary health impacts of diets
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