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Strid, A., Hallström, E., Lindroos, A. K., Lindahl, B., Johansson, I. & Winkvist, A. (2023). Adherence to the Swedish dietary guidelines and the impact on mortality and climate in a population-based cohort study. Public Health Nutrition
Open this publication in new window or tab >>Adherence to the Swedish dietary guidelines and the impact on mortality and climate in a population-based cohort study
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2023 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: To assess the associations between adherence to the Swedish dietary guidelines and all-cause mortality and thus assessing the index' ability to predict health outcomes, as well as levels of dietary greenhouse gas emissions (GHGEs). Design: A longitudinal study 1990-2016 within the population-based cohort Västerbotten Intervention Programme. Dietary data were based on food frequency questionnaires. Diet quality was assessed by the Swedish Healthy Eating Index for Adults 2015 (SHEIA15), based on the 2015 Swedish dietary guidelines. Dietary GHGEs were estimated from life cycle assessment data including emissions from farm to industry gate. Hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality were evaluated with Cox proportional hazards regression, and differences in median GHGEs were tested using the Kruskal-Wallis one-way ANOVA test, between quintiles of SHEIA15 score. Setting: Northern Sweden. Participants: In total, 49,124 women and 47,651 men, aged 35-65 years. Results: Median follow-up times were 16.0 years for women and 14.7 years for men, during which time 3074 women and 4212 men died. A consistent trend of lower all-cause mortality HRs for both sexes with higher SHEIA15 scores was demonstrated. For women, the all-cause mortality HR was 0.81 [(95% CI 0.71-0.92); p=0.001] and for men 0.90 [(95% CI 0.81-0.996); p=0.041] between the quintile with the highest SHEIA15 score compared with the quintile with the lowest SHEIA15 score. A consistent trend of lower estimated dietary GHGEs among both sexes with higher SHEIA15 scores was also found. Conclusions: Adherence to Swedish dietary guidelines, estimated by SHEIA15, seems to promote longevity and reduce dietary climate impact. © The Authors 2023.

Place, publisher, year, edition, pages
Cambridge University Press, 2023
Keywords
diet quality, dietary indices, food-based dietary guidelines, sustainability, sustainable diets, adult, aged, all cause mortality, analysis of variance, article, climate, cohort analysis, controlled study, diet, female, follow up, food frequency questionnaire, greenhouse gas emission, Healthy Eating Index, human, human experiment, life cycle assessment, longevity, longitudinal study, major clinical study, male, mortality, practice guideline, Sweden
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:ri:diva-65683 (URN)10.1017/S1368980023001295 (DOI)2-s2.0-85165115881 (Scopus ID)
Note

Funding: The Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas).

Available from: 2023-08-10 Created: 2023-08-10 Last updated: 2023-08-10Bibliographically approved
Åkesson, A., Donat-Vargas, C., Hallström, E., Sonesson, U., Widenfalk, A. & Wolk, A. (2023). Associations between dietary pesticide residue mixture exposure and mortality in a population-based prospective cohort of men and women. Environment International, 182, Article ID 108346.
Open this publication in new window or tab >>Associations between dietary pesticide residue mixture exposure and mortality in a population-based prospective cohort of men and women
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2023 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 182, article id 108346Article in journal (Refereed) Published
Abstract [en]

Background: There is a concern that pesticide residues, regularly detected in foods, might pose a health risk to the consumer, but epidemiological evidence is limited. We assessed the associations between dietary exposure to a mixture of pesticide residues and mortality. Methods: Food consumption was assessed in 68,844 participants from the Swedish Mammography Cohort and the Cohort of Swedish Men, 45–83 years at baseline (1997). Concentrations of pesticide residues detected in foods on the Swedish market (1996–1998), mainly fruits and vegetables, were obtained via monitoring programs. To assess mixture effects, we summed per food item the ratios of each single pesticide mean residue concentration divided by its acceptable daily intake to create for each participant a Dietary Pesticide Hazard Index (adjusted for energy intake and expressed per kilogram of body weight). Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95 % confidence intervals (95 %CI). Results: During 15 years of follow-up (1998–2014), a total of 16,527 deaths occurred, of which 6,238 were caused by cardiovascular disease (CVD) and 5,364 by cancer. Comparing extreme quintiles of Dietary Pesticide Hazard Index, the highest category was inversely associated with CVD mortality HR, 0.82 (95 % CI, 0.75–0.90) and with cancer mortality HR 0.82 (95 % CI 0.75–0.91). In analyses stratified by high/low Dietary Pesticide Hazard Index, similar inverse associations were observed by increasing fruit and vegetable consumption. Conclusions: We observed no indications that dietary exposure to pesticide residue mixtures was associated with increased mortality, nor any clear indications that the benefits of fruit and vegetable consumption on mortality was compromised. Yet, our results need to be interpreted with caution. © 2023 The Author(s)

Place, publisher, year, edition, pages
Elsevier Ltd, 2023
Keywords
Cardiovascular Diseases; Diet; Dietary Exposure; Female; Fruit; Humans; Male; Neoplasms; Pesticide Residues; Prospective Studies; Risk Factors; Vegetables; Sweden; Chemical contamination; Diseases; Food supply; Fruits; Hazards; Health risks; Nutrition; Vegetables; dietary pesticide residue; pesticide residue; unclassified drug; pesticide residue; All-cause mortality; Dietary exposure; Dietary pesticide residue exposure; Fruit and vegetables; Hazard indices; Hazard ratio; Nutritional epidemiology; Pesticide residue; Specific-mortality; Swedishs; cohort analysis; consumption behavior; dietary intake; health risk; mortality; pesticide residue; pollution exposure; risk assessment; adult; all cause mortality; Article; caloric intake; cancer mortality; cardiovascular disease; cardiovascular mortality; cohort analysis; controlled study; dietary exposure; female; follow up; food intake; fruit; fruit consumption; human; male; malignant neoplasm; middle aged; population research; prospective study; vegetable; vegetable consumption; analysis; cardiovascular disease; chemistry; diet; dietary exposure; neoplasm; risk factor; Pesticides
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:ri:diva-68806 (URN)10.1016/j.envint.2023.108346 (DOI)2-s2.0-85179717765 (Scopus ID)
Funder
Swedish Research Council Formas, 2016-00308Swedish Research Council, 2017-00822Swedish Research Council, 2017-00644
Note

The Swedish Research Council, Formas grant no 2016-00308, and the Swedish Research Council no 2017-00822 and 2017-00644 (SIMPLER) supported the study.

Available from: 2024-01-09 Created: 2024-01-09 Last updated: 2024-01-15Bibliographically approved
Shanmugam, K., Bryngelsson, S., Östergren, K. & Hallström, E. (2023). Climate Impact of Plant-based Meat Analogues: A Review of Life Cycle Assessments. Sustainable Production and Consumption, 36, 328-337
Open this publication in new window or tab >>Climate Impact of Plant-based Meat Analogues: A Review of Life Cycle Assessments
2023 (English)In: Sustainable Production and Consumption, ISSN 2352-5509, Vol. 36, p. 328-337Article, review/survey (Refereed) Published
Abstract [en]

The transition towards more plant-based diets is identified as an important measure for limiting dietary climate impact. Plant-based meat analogues (PBMAs) have been proposed as a viable lower carbon alternative to meat, and its market is rapidly growing globally. However, knowledge about the climate impact of PBMAs in relation to other foods is currently limited due to the challenge of comparing life cycle assessments (LCAs) using different methods. The aim of this study was to review the climate impact of PBMAs based on LCAs published up to 2021. Original LCA data were recalculated to harmonize differences in method choices among studies and presented as the climate impact of final products at factory gate. The median climate impact of PBMAs was estimated at 1.7 kg CO2 eq./kg of product with a more than fourfold variation in impact (0.5–2.4 kg CO2 eq./kg product). Climate impact per protein content of the final product varied from 0.4 to 1.2 kg CO2 eq./100 g protein with a median impact of 0.8 kg CO2 eq./100 g protein. Cultivation of raw materials and manufacturing were identified to be responsible for a large proportion of GHG emissions up to factory gate. However, the assessment of climate impact in the production chain was challenged by the level of detail of data provided. A transparent reporting strategy regarding the specific stages in the supply chain, method choices and product information is recommended to facilitate identification of hot spots to target for improved climate performance of future PBMAs and to enable accurate comparisons between studies. It could further be concluded that current scientific knowledge on the climate impact of PBMAs is based on a limited number of LCAs that often rely on a combination of secondary data and collected data at production scale or from pilot-scale production facilities. Future LCAs of PBMAs would benefit from additional assessments of commercial production using region- and site-specific data. © 2023 The Authors

Place, publisher, year, edition, pages
Elsevier B.V., 2023
Keywords
Climate, GHG emissions, Life cycle assessment (LCA), Meat analogue, Plant-based, Protein, Carbon dioxide, Cultivation, Greenhouse gases, Meats, Proteins, Supply chains, Climate impacts, G protein, GHG emission, GHGs emissions, Life cycle assessment, Low carbon, Meat analog, Plant-based diets, Life cycle
National Category
Climate Research
Identifiers
urn:nbn:se:ri:diva-63976 (URN)10.1016/j.spc.2023.01.014 (DOI)2-s2.0-85147324932 (Scopus ID)
Note

Correspondence Address: Hallström, E.; Research Institutes of Sweden (RISE), P.O. Box 5401, Sweden; Funding details: 2020-02839; Funding text 1: This article was performed with financial support by the Swedish Research Council for Sustainable Development (Formas) within the national center FINEST – Food Innovation Enabling Sustainable Transition [Grant no. 2020-02839 ]. The funder and industrial partners had no role in the design of the study, analysis or interpretation of data or in the writing of the manuscript.

Available from: 2023-02-22 Created: 2023-02-22 Last updated: 2023-05-23Bibliographically approved
Röös, E., Wood, A., Säll, S., Abu Hatab, A., Ahlgren, S., Hallström, E., . . . Hansson, H. (2023). Diagnostic, regenerative or fossil-free - exploring stakeholder perceptions of Swedish food system sustainability. Ecological Economics, 203, Article ID 107623.
Open this publication in new window or tab >>Diagnostic, regenerative or fossil-free - exploring stakeholder perceptions of Swedish food system sustainability
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2023 (English)In: Ecological Economics, ISSN 0921-8009, E-ISSN 1873-6106, Vol. 203, article id 107623Article in journal (Refereed) Published
Abstract [en]

In an analysis of food system sustainability challenges and solutions among Swedish food system actors using Q-methodology, five perspectives were identified. One of the main three perspectives placed the highest priority on reduced meat consumption, food waste, and climate impact in agriculture, but downplayed strategies highlighted in the national food strategy and social aspects, and can be interpreted as a diagnostic climate mitigation-oriented perspective that does not reflect current negotiated policy processes or ‘softer’ values of food. In an alternative regenerative perspective, industrialized large-scale farming and lack of internalization of external costs were regarded as the main problems, and diversity, soil health, and organic farming as the main solutions. Proponents of a third perspective regarded phasing out fossil fuels, increased profitability of companies, increased meat production, and self-sufficiency as high priorities. These contrasting views can be a major barrier to transforming the Swedish food system. However, a number of entry points for change (i.e. aspects highly important for some and neutral for others) were identified, including focusing on healthy diets and increased production of fruit and vegetables. Focusing on these can build trust among stakeholders before moving to discussions about the larger and more sensitive systemic changes needed. © 2022 The Authors

Place, publisher, year, edition, pages
Elsevier B.V., 2023
Keywords
Agriculture, Change agents, Climate change, Food production, Stakeholders, alternative agriculture, climate effect, organic farming, perception, stakeholder, sustainability, Sweden
National Category
Food Science
Identifiers
urn:nbn:se:ri:diva-61193 (URN)10.1016/j.ecolecon.2022.107623 (DOI)2-s2.0-85139395870 (Scopus ID)
Note

Funding details: DIA 2018/24 #8; Funding details: Stiftelsen för Miljöstrategisk Forskning; Funding details: Svenska Forskningsrådet Formas, 2019-01579; Funding text 1: The study was part of Mistra Food Futures ( DIA 2018/24 #8 ), a research program funded by Mistra (The Swedish Foundation for Strategic Environmental Research). All authors were funded by this program except A. Wood, who was supported by funding from Formas (grant number 2019-01579 ). All funding is gratefully acknowledged. Our thanks also go to all stakeholders who participated in workshops and in the sorting exercise.

Available from: 2022-12-06 Created: 2022-12-06 Last updated: 2023-06-08Bibliographically approved
Lindroos, A. K., Hallström, E., Moraeus, L., Strid, A. & Winkvist, A. (2023). Dietary Greenhouse Gas Emissions and Diet Quality in a Cross-Sectional Study of Swedish Adolescents. American Journal of Clinical Nutrition, 118(5), 956-965
Open this publication in new window or tab >>Dietary Greenhouse Gas Emissions and Diet Quality in a Cross-Sectional Study of Swedish Adolescents
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2023 (English)In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 118, no 5, p. 956-965Article in journal (Refereed) Published
Abstract [en]

Background: Interventions to improve dietary intake and reduce dietary greenhouse gas emissions (dGHGE) are urgently needed. Adolescence presents a unique time in life to promote sustainable diets. Detailed dietary data are needed to inform public health strategies aiming at improving adolescents’ diet quality and reducing dGHGE. Objective: This study aimed to describe dGHGE in Swedish adolescents’ diets by socio-demographic characteristics, evaluate how food groups contribute to dGHGE, and examine dGHGE in relation to diet quality. Methods: Data come from the national, school-based, cross-sectional dietary survey Riksmaten Adolescents 2016-17 of 3099 females and males attending school grades 5 (11–12 y old), 8 (14–15 y old) and 11 (17–18 y old). Participants completed 2 web-based 24-h recalls and questionnaires on lifestyle factors. dGHGE was estimated based on life cycle assessment data. Diet quality was estimated using NRF11.3 (Nutrient Rich Food Index) and SHEIA15 (Swedish Healthy Eating Index for Adolescents 2015). Results: dGHGE were higher in males than females (medians 4.2 versus 3.8 kg CO2e/10 MJ, P < 0.001). In females, dGHGE were highest in grade 5 (4.0 kg CO2e/10MJ), whereas in males, emissions were highest in grade 11 (4.4 kg CO2e/10MJ), P < 0.001 for the sex/grade interaction. Overweight/obesity was positively associated with CO2e/10MJ, but parental education, birthplace, and degree of urbanization were not. In females, the proportion of dGHGE from animal-based foods was lowest in grade 11, whereas the proportions from plant-based foods and sweet foods/beverages were highest. In males, these proportions were similar across grades. NRF11.3 was not associated with CO2e/10MJ, whereas healthier eating, according to SHEIA15, was inversely associated with CO2e/10MJ. Conclusions: Food choices and dGHGE per calorie differ by sex in adolescents. Thus, intervention strategies to improve dietary sustainability need to be tailored differently to females and males. Diet quality should also be considered when promoting reduced GHGE diets.

Place, publisher, year, edition, pages
Elsevier B.V., 2023
Keywords
adolescent; adolescent nutrition; adolescent obesity; adult; animal food; Article; caloric intake; carbon dioxide emission; child; climate change; controlled study; cross-sectional study; diet quality; dietary intake; educational status; environmental impact; female; food intake; food preference; greenhouse gas emission; Healthy Eating Index 2015; human; life cycle assessment; major clinical study; male; Nutrient Rich Food Index; nutritional parameters; Nutritional Risk Index; parent; place of birth; school child; sex difference; sociodemographics; Sweden; Swedish citizen; Swedish Healthy Eating Index for Adolescents 2015; sweetened beverage; urbanization; vegetarian diet
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:ri:diva-67698 (URN)10.1016/j.ajcnut.2023.09.001 (DOI)2-s2.0-85173270399 (Scopus ID)
Funder
Swedish Research Council Formas, 2019-00590
Note

The study was funded by the Swedish Research Council for Sustainable Development, Formas (dnr 2019-00590). The funding body was not involved in the study design collection, management, analysis, and interpretation of data.

Available from: 2023-11-06 Created: 2023-11-06 Last updated: 2023-11-16Bibliographically approved
Hornborg, S., Bianchi, M. A., Thomas, J.-B., Wocken, Y., Axelsson, A. F., Sanders, C., . . . Ziegler, F. (2023). Environmental and nutritional perspectives of algae.
Open this publication in new window or tab >>Environmental and nutritional perspectives of algae
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2023 (English)Report (Other academic)
Abstract [en]

Algae have gained increasing attention as promising food from both an environmental and nutritional perspective. However, current understanding is still limited. This report summarizes the status of knowledge for this emerging sector, focusing on micro- and macroalgae species most relevant for Europe (particularly Sweden). Environmental impacts, with focus on climate, are evaluated through literature reviews and analysis of existing life cycle assessments (LCAs), and nutritional potential in the form of data compilation and calculation of nutrient density scores. Overall, findings reveal that current data is incomplete and of poor representativeness. Most LCAs are not performed on commercial production, but at pilot or experimental scale, why often only indicative drivers for greenhouse gas emissions may be identified. For microalgae, there is a wide diversity of production systems in different conditions across the globe. Based on the data at hand, energy use is a key hotspot across most studies for this production, driven by the requirements of different types of systems and species, and to location. For macroalgae production, despite poor representativeness of especially green and red macroalgae, key aspects for minimizing greenhouse gas emissions are associated with energy consumption and use of materials for farming such as ropes. No LCA exists on wild harvested macroalgae, representing the largest production volume in Europe (>95%); large-scale wild harvest may also be associated with risks to ecosystems unless suitable management is enforced. Significant data gaps also exist in food composition databases regarding nutrient and heavy metal content in algae (e.g., vitamins and omega-3 fatty acids). When available, nutrient content was found to be highly variable within and across species, but overall, the evaluation of nutritional quality indicated that algae may be a considerable source of minerals and vitamin B12. The contribution of fiber and protein is generally minimal in a 5 g dry weight portion of macroalgae; microalgae may have higher protein content, and also fat. However, excessive amounts of iodine and several heavy metals may be represented even in very small amounts of unprocessed macroalgae. In summary, the suggested potential of farmed algae as a sustainable food resource is overall strengthened by its generally low carbon footprint during production compared to other food raw materials. However, more input data are needed to fill data gaps regarding both environmental impacts and nutrient quality, and effects from different processing, as well as improved understanding of nutrient and contaminant bioavailability. Pending further research, careful considerations of risks and benefits associated with algae production and consumption should be applied.

Publisher
p. 54
Series
RISE Rapport ; 2023:84
Keywords
algae, carbon footprint, environmental impact, nutrition, contaminants
National Category
Environmental Sciences
Identifiers
urn:nbn:se:ri:diva-66707 (URN)978-91-89821-57-6 (ISBN)
Note

This report represents an output of the research project ‘The role of algae in sustainable food systems- a knowledge synthesis of the nutritional quality and environmental impact’, funded by the Swedish Research Council Formas (grant 2020-03113).

Available from: 2023-09-11 Created: 2023-09-11 Last updated: 2024-01-25Bibliographically approved
Jacobsen, M., Bianchi, M. A., Trigo, J. P., Undeland, I., Hallström, E. & Bryngelsson, S. (2023). Nutritional and toxicological characteristics of Saccharina latissima, Ulva fenestrata, Ulva intestinalis, and Ulva rigida: a review. International journal of food properties, 26(1), 2349-2378
Open this publication in new window or tab >>Nutritional and toxicological characteristics of Saccharina latissima, Ulva fenestrata, Ulva intestinalis, and Ulva rigida: a review
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2023 (English)In: International journal of food properties, ISSN 1094-2912, E-ISSN 1532-2386, Vol. 26, no 1, p. 2349-2378Article in journal (Refereed) Published
Abstract [sv]

Nutrient and toxicant levels as well as their bioavailability in S. latissima and Ulva species (fenestrata, intestinalis, rigida) were reviewed. Nutritional quality was assessed by nutrient contribution to daily reference intake (DRI) per portion (5 g dry weight), nutrient density score NRF21.3, and comparisons to reference foods. Toxicological assessments comprised tolerable daily intake (TDI)-levels. Based on mean %DRI per portion, S. latissima and Ulva species were good sources (%DRI >15) of calcium, magnesium, iron, selenium, and vitamin B12. Mean %DRI was <10% for fiber, sodium, and protein. Toxicological concerns were mainly due to iodine (mean %TDI per portion: 3160% for S. latissima and 41–91% for Ulva species). Mean %TDIs for inorganic arsenic, cadmium, and lead were <20% for S. latissima and 9–97%, 6–15%, and 21–46%, for the selected Ulva species, respectively. Bioavailability data were scarce and is, together with nutritional impact of processing, an important aspect to address in future studies.

National Category
Food Science
Identifiers
urn:nbn:se:ri:diva-66100 (URN)10.1080/10942912.2023.2246677 (DOI)
Funder
Swedish Research Council Formas, 2020-03113
Note

This work was performed with financial support by the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas) [Grants 2020-03113; 2018-01839 (CirkAlg); 2021-02340 (BlueGreen)].

Available from: 2023-08-25 Created: 2023-08-25 Last updated: 2023-08-25Bibliographically approved
Sjons, J., Florén, B., Biörklund Helgesson, M., Hallström, E. & Nilsson, K. (2023). RISE klimatskalor för livsmedel.
Open this publication in new window or tab >>RISE klimatskalor för livsmedel
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2023 (Swedish)Report (Other academic)
Abstract [sv]

RISE Jordbruk och livsmedel har tagit fram tio klimatskalor för livsmedel med syftet att stötta aktörer i livsmedelskedjan genom att ge vägledning kring vad som är låg respektive hög klimatpåverkan inom en grupp av livsmedel med liknande funktion. Skalorna kan användas för att jämföra olika livsmedels klimatavtryck inom samma grupp av livsmedel och på så sätt främja mer klimatsmarta val av livsmedel. Målgruppen för klimatskalorna är användare av RISE klimatdatabas för livsmedel, såsom aktörer som producerar och säljer livsmedel och i slutänden deras kunder, konsumenterna. Även för kockar och andra måltidsaktörer är klimatskalorna tänkta som ett hjälpmedel i den dagliga menyplaneringen. Indelning av livsmedel i tio klimatskalor har gjorts utifrån livsmedlens funktion och användningsområden, se punktlista nedan. Fokus har varit på sju av de tio klimatskalorna vilka omfattar de livsmedelsgrupper som utgör den största delen av vår konsumtion. De övriga tre klimatskalorna, kursiverade i punktlistan nedan, inkluderar antingen produkter som ofta konsumeras i mindre mängder och är mer olika varandra och därmed inte direkt utbytbara, eller sammansatta rätter för vilka RISE klimatskala för måltider rekommenderas att användas i första hand.

Publisher
p. 34
Series
RISE Rapport ; 2023:57
Keywords
klimatskala, livsmedel, klimatavtryck, klimatpåverkan, klimatdatabas
National Category
Agricultural Science
Identifiers
urn:nbn:se:ri:diva-65527 (URN)978-91-89821-11-8 (ISBN)
Available from: 2023-06-22 Created: 2023-06-22 Last updated: 2024-02-06Bibliographically approved
Strid, A., Johansson, I., Lindahl, B., Hallström, E. & Winkvist, A. (2023). Toward a More Climate-Sustainable Diet: Possible Deleterious Impacts on Health When Diet Quality Is Ignored. Journal of Nutrition, 153(1), 242-252
Open this publication in new window or tab >>Toward a More Climate-Sustainable Diet: Possible Deleterious Impacts on Health When Diet Quality Is Ignored
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2023 (English)In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 153, no 1, p. 242-252Article in journal (Refereed) Published
Abstract [en]

Background Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets. Objectives To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs. Methods Dietary data of 41,194 women and 39,141 men (35–65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact. Results Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men. Conclusions The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.

Keywords
carbon dioxide equivalents, cardiovascular disease, climate impact, diet quality, food frequency questionnaire, myocardial infarction, nutrient density, NRF index, nutrient profiling, stroke
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:ri:diva-62450 (URN)10.1016/j.tjnut.2022.10.004 (DOI)
Note

The Northern Sweden Diet Database was supported by the Swedish Research Council for Health, Working Life and Welfare and the Swedish Research Council. The current project was supported by a grant from the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (For-mas, grant number: FR-2019/0007 to AW).

Available from: 2023-01-23 Created: 2023-01-23 Last updated: 2023-12-22Bibliographically approved
Strid, A., Hallström, E., Lindroos, A. K., Lindahl, B., Johansson, I. & Winkvist, A. (2022). Adherence to the Swedish Dietary Guidelines and the Impact on Mortality and Climate in a Population-Based Cohort Study. Current Developments in Nutrition, 6(Suppl 1), 950-950
Open this publication in new window or tab >>Adherence to the Swedish Dietary Guidelines and the Impact on Mortality and Climate in a Population-Based Cohort Study
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2022 (English)In: Current Developments in Nutrition, E-ISSN 2475-2991, Vol. 6, no Suppl 1, p. 950-950Article in journal (Refereed) Published
Abstract [en]

Abstract <sec> Objectives <p>To assess 1) the association between adherence to the Swedish dietary guidelines and all-cause mortality, and 2) the difference in greenhouse gas emissions (GHGE) from diets of participants with higher and lower adherence to the Swedish dietary guidelines.</p> </sec> <sec> Methods <p>Dietary data from the Swedish population-based cohort Västerbotten Intervention Programme (49,124 women and 47,651 men, 35–65 years at baseline), collected between the years 1990–2016, were used. Diet quality was assessed by the Swedish Healthy Eating Index for Adults 2015 (SHEIA15). SHEIA15 is based on the Swedish dietary guidelines from 2015, and includes assessments of intakes of vegetables and fruits, seafood, whole grains, fiber, monounsaturated fatty acids, polyunsaturated fatty acids, saturated fatty acids, red and processed meat and added sugar. GHGE of diets were estimated from life cycle assessment data, including CO<sub>2</sub>e from primary production to industry gate. Information on all-cause mortality was acquired from registers at the National Board of Health and Welfare in Sweden using personal identification numbers. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards regression, comparing the lowest and highest quintile of SHEIA15 score. Potential confounders were adjusted for. Difference in GHGE of diets was compared between the lowest and highest quintile of SHEIA15 score, using the Mann Whitney U test.</p> </sec> <sec> Results <p>Median follow-up times were for women 16.0 years and for men 14.7 years, during which time 3074 women and 4212 men died. For women the highest SHEIA15 score was associated with lower mortality compared with the lowest score (HR: 0.87; 95% CI: 0.77, 0.98; P = 0.027). No statistically significant difference in HR of mortality was found for the men with the highest SHEIA15 score compared with the lowest score (HR: 0.91; 95% CI: 0.82, 1.01; P = 0.083). The participants with the highest score of SHEIA15 had lower dietary GHGE compared to those with the lowest score in both women and men (P &lt; 0.001).</p> </sec> <sec> Conclusions <p>Higher adherence to the Swedish dietary guidelines, estimated by SHEIA15, was associated with lower all-cause mortality for women, but not for men, and indicated lower GHGE from diets for both women and men.</p> </sec> <sec> Funding Sources <p>The Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas).</p> </sec>

National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:ri:diva-63462 (URN)10.1093/cdn/nzac067.070 (DOI)
Note

Funding Sources: The Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas).

Available from: 2023-01-30 Created: 2023-01-30 Last updated: 2023-03-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0522-3591

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