Note

Purpose: This study characterises food and nutrient intake in self-reported diets with varying environmental impacts and evaluates their adherence to dietary guidelines and nutritional adequacy, exploring co-benefits and trade-offs between environmental impact and diet quality. Methods: Dietary data were from two population-based cohorts (n = 30 000) of Swedish adults aged 56–70 years. Environmental impact was assessed using an aggregated score based on six environmental indicators. Adherence to dietary guidelines and nutritional adequacy was evaluated against the Nordic Nutrition Recommendations 2023. Results: In line with the dietary guidelines, diets with a lower environmental impact had lower intake of red meat, processed meat, sugar-sweetened beverages, high-fat dairy products, saturated fat, sodium and alcohol, alongside higher intake of whole grains, fibre and polyunsaturated fat. Contrary to the dietary guidelines, lower-impact diets had higher intake of sweets and snacks and lower intake of vegetables, fruits and berries, nuts and seeds, and seafood. While lower-impact diets had a lower intake of protein and most vitamins and minerals, adherence to macronutrient recommendations was generally higher, and micronutrient intake was adequate, except for selenium and vitamin D. Conclusions: This study highlights both co-benefits and trade-offs between environmental and health goals. To prevent negative health effects from diets with lower environmental impact, it is essential to limit foods with low nutritional value (e.g., sweets and snacks) and promote healthy plant-based foods. Potential risks associated with a lower micronutrient intake should be considered, particularly for groups with special requirements, such as children, adolescents, fertile and pregnant women, and the elderly

[No abstract available]

Background: Public interest in plant-based dairy analogues is increasing; thus, their assessment by front-of-pack nutrition labelling schemes such as Keyhole and Nutri-Score can facilitate the identification of products with optimal nutritional quality. In this study, Keyhole and the latest version of Nutri-Score criteria were applied to plant-based dairy analogues (i.e., milk, yoghurt, cheese, cream, fat spread, and ice cream analogues) in the Swedish market to evaluate their nutritional quality. Methods: Nutritional data for 222 plant-based dairy analogues were collected from food manufacturers’ websites, and the eligibility of these analogues for Keyhole and Nutri-Score (A to E) were assessed. Products eligible for Keyhole and Nutri-Score A or B were deemed to have optimal nutritional quality. Results: 16% of plant-based milk analogues (from oat-, almond-, rice-, and potato-based products), 2% of plant-based yoghurt analogues and 37% of plant-based fat spread analogues were eligible for Keyhole. The plant-based cheese, cream and ice cream analogues were ineligible for Keyhole. None of the plant-based milk analogues qualified for Nutri-Score A, and 45% (mainly soy-, almond-, coconut-, pea- and mixed-based products) qualified for Nutri-Score B. 68% of plant-based yoghurt analogues (from oat-, soy-, almond- and mixed-based products) qualified for Nutri-Score A or B. The plant-based cheese, fat spread and ice cream analogues were ineligible for Nutri-Score A or B and 32% of plant-based cream analogues qualified for Nutri-Score B. A higher percentage of organic milk analogues and a lower percentage of organic yoghurt analogues were eligible for Keyhole and Nutri-Score A or B compared to their non-organic varieties. Keyhole and Nutri-Score had an agreement on classifying two plant-based dairy analogues as optimal nutritional quality products and 133 plant-based dairy analogues as suboptimal. Conclusions: There is variability in the eligibility of plant-based dairy analogues for Keyhole and Nutri-Score labelling. Eligibility for Keyhole was highest among plant-based fat spread analogues, while Nutri-Score A and B ratings were more common for plant-based yoghurt analogues. Plant-based cheese and ice cream analogues were ineligible for Keyhole and Nutri-Score A or B. Since the micronutrient content of organic and non-organic plant-based dairy analogues did not affect their evaluation by Keyhole and Nutri-Score, this limitation warrants further consideration. 

Background: The global food system is a major contributor to climate change, accounting for about one-third of human-induced greenhouse gas emissions (GHGE). Shifting toward plant-based diets offers potential benefits for both planetary health and chronic disease prevention. However, epidemiological evidence linking dietary GHGE to health outcomes remains limited and inconsistent. Objective: To examine the associations between dietary GHGE and the risk of all-cause and cause-specific mortality, cardiovascular disease (CVD), and type 2 diabetes in a large Swedish cohort. Methods: This prospective cohort study included 22,388 adults (45–73 years) from the Malmö Diet and Cancer study. Dietary intake was assessed through a validated modified diet history method and linked to GHGE estimates using life cycle assessment data. Cox proportional hazards models were used to assess associations between GHGE and disease outcomes, adjusting for sociodemographic and lifestyle factors. Results: Over a mean follow-up of 28.5 years, 11,213 deaths, 5322 CVD cases, and 4324 diabetes cases were documented through registers. Higher GHGE were consistently associated with higher risk of diabetes (p > 0.001). For all-cause and CVD mortality, moderate positive associations were observed, particularly among participants with very high GHGE. When participants who reported substantial dietary changes prior to baseline were excluded, a significant linear association was observed for cancer mortality and CVD incidence. Conclusion: Diets with higher climate impact were associated with adverse health outcomes, especially diabetes incidence. These findings suggest that climate-friendly diets may also confer health benefits. Future studies should transparently report GHGE modelling approaches and clarify the roles of specific dietary components in improving both health and environmental outcomes.

Background: Dietary shift is necessary for improving public health, mitigating climate change, and achieving the Sustainable Development Goals. Adaption of climate-friendly diets might prevent chronic diseases and reduce mortality; however, consuming diets with a low climate impact have been suggested to increase risk of some micronutrient deficiencies. Objectives: This study aimed to examine whether self-reported dietary intake varying in climate impact is associated with nutritional risks and benefits based on both dietary intakes and blood concentrations of micronutrients. Methods: In the cross-sectional Malmö Diet and Cancer cohort (MDC, n = 25,970), dietary data were collected using a modified diet history method (food frequency questionnaire, diary, and interview). Blood samples were drawn and analyzed for micronutrients in different subgroups. Life cycle assessment data were used to estimate dietary greenhouse gas emissions (GHGE), from farm to fork. Quintiles of dietary climate impact were examined in relation to nutrient intake and status using linear and logistic regression. Results: The mean estimated dietary GHGE were 5.9 kg of carbon dioxide equivalents per day (females: 5.4, males: 6.6). Participants consuming a more climate-friendly diet had lower proportion of animal-sourced foods, energy intake, and intake of all micronutrients assessed (n = 17). Prevalence of anemia was higher in females consuming more climate-friendly diets, but the rates were low across all climate-diet groups (4.6% in Q1 compared with 3.3% in Q5; P-trend: 0.02), but not in males (P-trend: 0.131). No significant trends were observed in nutrient status of vitamin D, selenium, zinc, and folate across dietary GHGE quintiles. Conclusions: Despite a lower intake of micronutrients, more climate-friendly diets did not substantially increase risk of deficiencies. The study highlights the importance of measuring both nutrient intake and status when discussing nutritional consequences of sustainable eating.

Background: Human diets account for 30% of greenhouse gas emissions (GHGE). Reporting dietary GHGE with or without energy standardization yields different outcomes, often resulting in conflicting conclusions regarding associations with micronutrient intake. Objectives: This study aims to compare methods of reporting dietary GHGE, with and without consideration of energy intake, and their respective associations with micronutrient intake. Methods: Data were sourced from the Malmö Diet and Cancer Study, a cohort involving 25,970 participants. GHGE were estimated based on life cycle assessment data. The study explores different methods of reporting dietary climate impact: GHGE per day, GHGE per 1000 kcal, and with different energy adjustments. Association with micronutrient intake was modeled as daily intake and per 1000 kcal using linear regression models. Results: Diets with higher GHGE per day were associated with a higher daily intake of all 17 examined micronutrients. When energy was included in the model, the results for GHGE per 1000 kcal aligned well with those for GHGE per day. However, using GHGE per 1000 kcal generally showed that higher GHGE were linked to lower daily micronutrient intake. Different methods of adjusting for energy intake yielded estimates with varying directions and magnitudes of associations. Conclusions: This study highlights the implications of energy intake when assessing the impact of dietary GHGE and demonstrates that the choice of GHGE modeling approach might have important consequences for the results and interpretation. The method of choice for modeling dietary GHGE in relation to micronutrient intake needs to be carefully considered in future studies.

The global food system contributes roughly one-third of global greenhouse gas emissions (GHGEs) making shifts towards more sustainable food consumption an imperative. Such diets also need to factor in nutrient requirements and cultural acceptability. Our aim was to simulate dietary changes for adolescents in Sweden to achieve the recommended intake (RI) for vitamin D while factoring in additional nutrients, cultural acceptability and keeping the diet within planetary boundaries for climate change. A baseline diet was estimated from Sweden’s national dietary survey Riksmaten Adolescents 2016–17 (n = 3099, ages 11–18 years), which provided food intake via two 24-hour recalls. Intake data were linked to the Swedish Food Agency’s food composition database and GHGE estimates from the Research Institutes of Sweden’s (RISE) Food Climate Database. Linear programming was used to optimize the baseline diet to meet the RI for vitamin D (10 µg/day), reduce GHGEs to ≤ 1.7 kg CO2-equivalents/person/day, and minimize dietary changes from baseline to factor in cultural acceptability. A second optimization included 25 additional nutrients requirements. Both optimized diets met their respective requirements reducing GHGEs by 54 % but relied heavily on milk and yoghurt (fortified by law), which provided > 60 % of vitamin D intake. Both diets also required major shifts toward plant-based foods and the second optimization demanded a five-fold greater change in diet from baseline compared to first optimization. Results suggest that adolescents in Sweden can achieve RIs for vitamin D and other nutrients while greatly reducing diet-related GHGEs, though cultural acceptability may be a challenge. 

Purpose: The risk of inadequate micronutrient intake is a concern of low-climate impact diets. This study analyzes the prevalence of iron deficiency (ID) among adolescents with varying dietary climate impact, with special reference to different types and dietary sources of iron. Methods: Data on dietary intake (n = 3099) and plasma ferritin (n = 1030) were from Riksmaten Adolescents 2016–2017 survey of Swedish girls and boys aged 11–18 years. Dietary climate impact was estimated with life cycle assessment data. Linear and logistic regression models assessed associations between dietary climate impact, intakes of iron and food groups, and ID. Results: Higher total iron and heme, but not non-heme, iron intake, was linearly associated with higher dietary climate impact. Compared to girls, boys had higher climate impact and low prevalence of ID. Girls in the highest climate impact quartile had 56% lower odds of ID (OR 0.44, 95% CI 0.24–0.81) compared to the lowest quartile, whereas no association was found in boys. Lower intake of red meat and heme iron was associated with ID in girls, while higher intake of dairy was associated with ID in boys. Menstruating girls and adolescents born outside of Sweden were identified risk groups for ID. Conclusions: Girls with a more climate-friendly diet and lower intake of red meat/heme iron may be at higher risk of ID compared to girls with higher dietary climate impact. These results highlight the importance of considering risk groups of ID, such as menstruating girls, in the transition to more plant-based diets with lower climate impact.