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AJCN. First published ahead of print August 1, 2012 as doi: 10.3945/ajcn.112.038729.

Sustainable diets for the future: can we contribute to reducing greenhouse gas emissions by eating a healthy diet? 13

Jennie I Macdiarmid, Janet Kyle, Graham W Horgan, Jennifer Loe, Claire Fyfe, Alexandra Johnstone, and Geraldine McNeill

ABSTRACT Background: Food systems account for 18–20% of UK annual greenhouse gas emissions (GHGEs). Recommendations for improv- ing food choices to reduce GHGEs must be balanced against dietary requirements for health. Objective: We assessed whether a reduction in GHGEs can be achieved while meeting dietary requirements for health. Design : A database was created that linked nutrient composition and GHGE data for 82 food groups. Linear programming was used iteratively to produce a diet that met the dietary requirements of an adult woman (19–50 y old) while minimizing GHGEs. Acceptabil- ity constraints were added to the model to include foods commonly consumed in the United Kingdom in sensible quantities. A sample menu was created to ensure that the quantities and types of food generated from the model could be combined into a realistic 7-d diet. Reductions in GHGEs of the diets were set against 1990 emis- sion values. Results : The first model, without any acceptability constraints, pro- duced a 90% reduction in GHGEs but included only 7 food items, all in unrealistic quantities. The addition of acceptability constraints gave a more realistic diet with 52 foods but reduced GHGEs by a lesser amount of 36%. This diet included meat products but in smaller amounts than in the current diet. The retail cost of the diet was comparable to the average UK expenditure on food. Conclusion: A sustainable diet that meets dietary requirements for health with lower GHGEs can be achieved without eliminating meat or dairy products or increasing the cost to the consumer. Am J Clin Nutr doi: 10.3945/ajcn.112.038729.

INTRODUCTION

Two challenges for public health and nutrition are climate change and obesity (1). It is recognized that current consumption patterns contribute to both of these issues and need to be tackled together to ensure consistent dietary advice for consumers while avoiding any unintended consequences by addressing them separately. In the United Kingdom, as in many other countries, the diet of the population fails to meet dietary recommendations by exceeding the maximum recommendations for saturated fatty acids, added sugars (ie, non-milk extrinsic sugars), and sodium and failing to achieve minimum recommendations for fiber (2). These consumption patterns not only fuel a high prevalence of obesity but also contribute significantly to climate change through high greenhouse gas emissions (GHGEs) 4 (3).

It is estimated that the food system accounts for 18–20% of all GHGEs in the United Kingdom, and the percentage increases to 30% if the impact of land use change is taken into account (4). GHGEs occur at every stage in the life cycle of a food from primary production through to processing, packaging, distribu- tion, consumption, and waste. As a result, GHGEs of different food groups vary widely, and meat and dairy make the greatest contribution to GHGEs in the diet (5–7). Many countries have made international (eg, the Kyoto protocol) and national (eg, Climate Change Act UK 2008) commitments to reduce GHGEs,

and to achieve these, the food sector will have to play a signif- icant role. This will require efficiency savings in the primary production and processing of food and changes in consumer behavior to adopt a diet with lower GHGEs. The concept of a sustainable diet is not new (8, 9), but it is

a complex issue, and there are still many gaps in our un- derstanding of what a sustainable diet might comprise (10). The complexity is captured in the following recent FAO definition of

a sustainable diet: “those diets with low environmental impacts

which contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, cul- turally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing nat- ural and human resources” (11). The aim of this study was to take one element of environmental

sustainability (ie, GHGEs) and test the compatibility of diets that meet dietary requirements for health with dietary changes needed

to reduce GHGEs by using mathematical modeling. An important

and, to our knowledge, novel element of the study was to go

1 From the Rowett Institute of Nutrition and Health (JIM, JL, CF, AJ, and GM) and the Division of Applied Health Sciences (JK and GM), University of Aberdeen, Aberdeen, United Kingdom, and Biomathematics and Statistics Scotland, Aberdeen, United Kingdom (GWH).

2 Supported by the World Wildlife Fund-United Kingdom & Scottish Gov- ernment Rural and Environment Science and Analytical Services.

3 Address correspondence to Jennie I Macdiarmid, Public Health Nutrition Research Group, Polwarth Building (1.073), Foresterhill, University of Aber- deen, Aberdeen, AB25 2DZ, United Kingdom. E-mail: j.macdiarmid@abdn. ac.uk.

4 Abbreviations used: CO 2 e, carbon dioxide equivalents; GHGE, greenhouse gas emission; LCA, life cycle analysis; RDC, regional distribution center. ReceivedMarch 12, 2012. Accepted for publication June 11, 2012. doi: 10.3945/ajcn.112.038729.

Am J Clin Nutr doi: 10.3945/ajcn.112.038729. Printed in USA. 2012 American Society for Nutrition

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Copyright (C) 2012 by the American Society for Nutrition

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MACDIARMID ET AL

beyond the mathematical modeling, which simply generated combinations of quantities of different food, to create and prepare a sample menu to test whether the food lists were realistic, ac- ceptable, and affordable for the general population.

METHODS

Nutrient composition and GHGE data

A database of 82 food groups was created that included the nutrient composition and GHGEs of each food in the form in which the foods would be consumed (eg, cooked weights and edible portion of the food).

Nutrient data

Nutrient composition data were based on data from the UK National Diet and Nutrition Survey databank (12), and the composition of each food group was calculated from the average of several similar food items. Soya or mycroprotein products as alternatives for animal-based products were not included because they are not commonly consumed in the average UK diet, and the purpose was to create an acceptable diet for the majority of the population.

GHGE data

Life cycle analysis (LCA) is an approach used for the esti- mation of GHGEs throughout the stages of production and consumption of a food (13). A full LCA is complex and involves a very detailed assessment of a product from emissions from agriculture and primary production through processing, trans- portation, retail, home use, and waste disposal. Because of the challenge of the assessment of GHGEs at all these stages for individual products, there are relatively few published data for the full LCA of individual food items. At the time of this study, the most comprehensive list of GHGE data for a range of primary food commodities consumed in the United Kingdom was pub- lished by Audsley et al (4). These data do not represent the full life cycle of food items but, rather, average GHGEs for the production of primary food commodities up to the regional distribution center (RDC). The RDC is described as a nominal boundary of primary production up to the point of distribution; therefore, it is based predominantly on GHGEs of production of primary commodities (eg, wheat, sugar, potatoes, beef, and milk) rather than the later stages of processing the ingredients into different food products (eg, bread, biscuits, crisps, pizza). With the use of data for all foods consumed in the United Kingdom, Audsley et al (4) estimate that w56% of total GHGEs are generated up to the point of the RDC. For the purpose of the current study, GHGEs of processed foods were estimated by using the ingredients that make up the foods consistent with work by Walle´ n et al (6) and using recipes from the sixth edition of McCance and Widdowson’s The Composition of Foods and Supplements (14). GHGE data were initially based on the weight of the raw product, and thus, these had to be adjusted to represent the food as eaten (eg, the edible portion of food and weight after cooking) to be compatible with the nutrient-composition data. Therefore, GHGE values were increased to account for weight losses during cooking (eg, for meat and fish) or only the edible proportion of food items (eg, for fruit and vegetables) and decreased to account for any weight

increase through hydration when cooked (eg, for rice and pasta). For example, the GHGE for uncooked rice is estimated to be 3.5 kg carbon dioxide equivalent (CO 2 e)/kg raw rice (4), but with hydration, it was recalculated to be 1.4 kg CO 2 e/kg for the equivalent weight of cooked rice. GHGEs can also vary for the same food item depending on how and where it is produced; eg, it has been estimated that the average GHGE for beef consumed in the United Kingdom can vary from 12.1 to 32.0 kg CO 2 e/kg depending on whether it was produced in the United Kingdom or outside of Europe, re- spectively (4). The higher emissions are the result not of transportation but of different farming methods because higher GHGEs tend to be associated with less intensive farming methods (15). Food consumed in the United Kingdom comes from a variety of different countries, and therefore, it was im- portant that this variety was accounted for in the GHGE data used in this study. The average GHGE for each food was cal- culated to reflect the proportion of the food imported and do- mestically produced for UK consumption by using data from HM Revenue & Customs UK Trade Statistics (16). Foods with high, medium, and low GHGEs are shown in Table 1.

Dietary requirements and GHGE target

The diet for this study was modeled on the UK dietary re- quirements of an adult woman (19–50 y old) by using the current UK dietary recommendation for health (17). The diet was based on the requirements of a woman because women have higher iron but lower energy requirements than men do. It was im- portant that any new diet contained sufficient iron because recent national surveys showed that, at a population level, many women and older girls have low intakes of iron (2, 18), and foods such as red meat, which has a high heme iron content, were likely to be restricted in a sustainable diet to reduce GHGEs. Energy and nutrient requirements for the diet are listed in Table 2. The min- imum requirement of protein was increased from 45 to 53 g/d to account for a higher proportion of protein that came from plant sources in the new diet because the digestibility of the protein from plant sources is only w 85% compared with .95% from meat (17, 19). The reduction in GHGEs for the diet was set against the UK 1990 GHGE figure because this is typically used as the baseline for GHGE-reduction targets (20, 21). The GHGE of food sup- plied and consumed in the United Kingdom in 1990 has been estimated to be w 152 Metric ton CO 2 e/y (4), which, by simply dividing by the size of the population, is equivalent to 7.28 kg CO 2 e/d. However, this figure assumes equal energy consumption across the population. With adjustment for the different energy requirements of the population age and sex structure, the total GHGE for the diet of an average woman (aged 19–50 y) was estimated to be 6.74 kg CO 2 e/d or 3.77 kg CO 2 e/d for GHGEs up to the RDC (ie, 56% of the total GHGE). The figure of 3.77 kg CO 2 e/d was used as the baseline for the reduction in GHGEs in the diets in this study.

Linear programming optimization

Linear programming is a mathematical modeling technique (22) used in other studies to construct nutritionally complete diets while optimizing another outcomes, such as the cost of the

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TABLE 1 Greenhouse gas emissions of different food groups on the basis of food supplied to and produced within the United Kingdom 1

Low GHGEs (,1.0 kg CO 2 e/kg edible weight)

Medium GHGEs (1.0–4.0 kg CO 2 e/kg edible weight)

High GHGEs (.4.0 kg CO 2 e/kg edible weight)

Potatoes

Chicken

Beef

Pasta, noodles

Milk, butter, yogurt

Lamb

Bread

Eggs

Pork

Oats

Rice

Turkey

Vegetables (eg, onions, peas, carrots, sweet corn, brassicas)

Breakfast cereal

Fish

Fruits (eg, apples, pears, citrus fruit, plums, grapes) Beans, lentils Confectionery, sugar Savory snacks

Spreads Nuts, seeds Biscuits, cakes, desserts Fruits (eg, berries, banana, melons) Salad vegetables Vegetables (eg, mushrooms, green beans, cauliflower, broccoli, squash)

Cheese

1 All GHGE values were adjusted to represent the edible weight as cooked and/or the edible portion of each product and adjusted to reflect the import:

domestic production ratio of produce consumed in the United Kingdom. GHGEs were based on the preregion distribution center rather than a full life cycle analysis. CO 2 e, carbon dioxide equivalent; GHGEs, greenhouse gas emissions.

diet (23–25). In this study, the outcome was to minimize the environmental impact of the diet (ie, GHGEs). To construct a diet that consisted of amounts of n food groups (x 1 , x 2 , . , x n ), each food group was associated with the GHGE per unit weight of an amount e i as follows:

ð1Þ

GHGE of the diet ¼ e 1 x 1 þ e 2 x 2 þ

:

: þ e n x n

The diet had to provide sufficient energy and meet the nutrient requirements listed in Table 2. With macronutrient and micro- nutrient requirement limits, which were denoted as b 1 , b 2 , . , b m ,

and with each food group i contributing a ij per unit weight to requirement j , a set of j dietary constraints were established such that:

ð2 Þ

a 1j x 1 þ a 2j x 2 þ

:

: þ a nj x n b j

These constraints were of the following 3 types: constraints with a lower limit (protein, fiber, complex carbohydrates, vita- mins, and minerals), constraints with an upper limit (sodium, total fat, saturated fatty acids, and nonmilk extrinsic sugars), and a constraint for which there was exact equality (energy). The model

TABLE 2 Energy, nutrient, and food intakes for the final sustainable diet (with acceptability constraints) compared with dietary requirements and the average dietary intake of a woman in the United Kingdom from the NDNS 1

Daily

Sustainable

NDNS 2008–2010 (n = 461)

 

requirements

diet

Energy (MJ) Total fat (percentage of food energy) Saturated fat (percentage of food energy) Total carbohydrate (percentage of food energy) Non-milk extrinsic sugar (percentage of food energy) Nonstarch polysaccharide (g) Protein (g) Iron (mg) Folate ( mg) Vitamin B-12 ( mg)

8.1

8.1

6.88 6 2.0 2 34.4 6 6.9 12.6 6 3.4 48.3 6 7.5 12.2 6 7.0 12.8 6 4.5 65.4 6 18.1 9.8 6 3.0 232 6 83 4.7 6 3.5 7.7 6 2.4 740 6 254

,35

28.4

,11

10.4

.50

54.9

,11

8.4

.18

23

$53

80

$14.8 3

14.7

$200 3

327

$1.5

3

5.7

 

$7.0

3

10.0

Zinc (mg) Calcium (mg) Sodium (mg)

$700 3 1600 (maximum 2400) 3

1015

2400

2029

4

Food groups Fish (g/wk) Red and processed meat (g/wk) 5 Fruit and vegetables, including fruit juice g/d Portions/d

2 portions

223

161

,500

190

392

$400

555

330

5.0

6.9

4.1

1 From Bates et al (2). NDNS, National Diet and Nutrition Survey.

2 Mean 6 SD (all such values).

3 Reference nutrient intakes [the amount to meet the needs of 97.5% of the population (15)].

4 Does not include salt added to meals.

5 Red meat includes beef, lamb, and pork.

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included constraints for 6 micronutrients (zinc, iron, calcium, vitamin B-12, folate, and sodium), which were selected either

because they are largely derived from animal products or because

a large proportion of the UK population does not currently meet

recommended intakes. In addition, the diet also had to achieve UK recommendations for fish intake of 2 portions/wk, one of which should be oily fish (26). The linear programming was first run with only energy and nutrient constraints, but as observed in previous studies (27), diets generated by using this methodology tend to include only a small number of food items, mostly in unrealistic quantities. To include more food items in the diet, lower or upper weight limits were placed

on the quantity of each food that could be selected from the database. Upper limits restricted the maximum quantity of a food that could be included in the diet, whereas lower limits forced foods into the diet that would not have been selected because of high GHGEs or

a low nutritional quality. These limits were referred to as ac-

ceptability constraints, which were based on foods consumed by

$50% of the UK population (taken from intake data from the National Diet and Nutrition Survey) (28). The acceptability of

a diet is subjective and varies between individuals, but for the

purpose of this study, it was based on what is commonly consumed by the population. Throughout this article, the diets generated by the linear programming is referred to as a sustainable diet. Linear programming was carried out by using the GNU Linear Programming Kit as implemented in the Rglpk (0.3–5) package of the R (2.11) statistical software environment (R Foundation for Statistical Computing).

Creating sample menus for a healthy and sustainable diet

Linear programming mathematically optimizes a list of foods that met the constraints while minimizing GHGEs. The next step was to create a sample 7-d menu to test whether the types and quantities of the foods generated could be combined into a realistic diet for the UK population. To finalize the sample sustainable diet, an iterative process

was used that required the program to be rerun by adjusting the upper and lower weight limits of individual foods until the quantities of food items could be combined into a weekly menu, while still meeting the dietary constraints. It was also important that perishable foods with

a limited storage life, such as fruit, were only included in whole units

to minimize waste. Once the sample 7-d menu had been created, all meals and recipes were prepared in the metabolic kitchen at the Human Nutrition Unit at the Rowett Institute of Nutrition and Health to ensure that the quantities of each food were appropriate. The nutrient content of the diet was also compared with the nutrient requirements for essential micronutrients that had not been specified as constraints in the model by using the WinDiets dietary assessment program (Univation Ltd, The Robert Gordon University). The diet was compared with the current average intake of women in the United Kingdom (2). For this calculation, the contribution of food groups for the 2 diets was determined by weight, with the weight of liquids (eg, milk or fruit juice) halved to adjust for the high water content compared with that of solid foods (29).

RESULTS

Sustainable diet without acceptability constraints

The program was run first without the acceptability con- straints, which generated a diet that met all energy and nutrient

requirements with a 90% reduction in the GHGE (0.39 kg CO 2 e/ d) but consisted of only 7 foods (whole-grain breakfast cereal, pasta, peas, fried onions, brassicas, sesame seeds, and confec- tionery). The objective of this model was to minimize GHGEs, therefore foods high in GHGEs, such as meat and dairy prod- ucts, were not selected when it was possible to get the required nutrients from other foods. Many of the micronutrient requirements were adequately met by breakfast cereals, which are usually for- tified with vitamins and minerals. However, the amounts required were large and unrealistic to be included in the diet. This diet was unrealistic not only because of the limited range of foods but also the inappropriate combinations of foods (eg, a large quantity of breakfast cereal with no milk).

Sustainable diet with acceptability constraints

Types and quantities of foods for a week that were included in the final version of the sustainable diet are shown in Table 3 . The inclusion of acceptability constraints resulted in a diet that was much more realistic. This diet included 52 different food groups and met energy, nutrient, and fish recommendation specified in the model plus recommended minimum intakes for fruit and vegetables and did not exceed the maximum recommendation for red and processed meat (Table 2). The diet also met other micronutrient requirements that were not included as constraints in the model (ie, vitamins A, B-6, C, thiamine, riboflavin, niacin, and magnesium). The final diet included 372 g meat/wk, of which 190 g was red meat (of which 20 g was processed meat). This amount of meat provided enough meat for w 4 main meals if used in quantities that matched typical meals in the United Kingdom today. Al- ternatively, meat could be included in 7 main meals by using smaller quantities and adding other ingredients such as vegeta- bles or beans to bulk out the dish or by increasing the ratio of starchy food to meat in a meal. The quantity of milk in the di- et allowed enough to be added to the breakfast cereal and for addition to w 3 hot drinks/d. Sufficient fruit and vegetables were included to achieve the minimum recommendation of 5 por- tions/d (400 g/d). The sample 7-d menu showed that the quantities of each food could be combined into a realistic diet with appropriate links between amounts of key food groups (eg, milk and breakfast cereals). The menu was based on 3 meals/d (breakfast, lunch, and an evening meal) plus snacks that could be consumed at any time of day, including at mealtimes. Examples of 4 d from the 7-d menu to illustrate the types of meals that were included are shown in Table 4. However, the inclusion of a greater variety of foods in the final sustainable diet was at the expense of the reduction in GHGEs. The GHGE of the final diet was estimated to be 2.43 kg CO 2 e/d (a reduction of 36% from the 1990 baseline). This reduction, however, was based on emissions per person with the assump- tion of the population size in 1990, but current and future annual emissions that are based on this diet need to take into account current and projected population growths. With the use of the Office of National Statistics current population estimates and projected estimates for the United Kingdom, it was calculated that the reduction would be equivalent to 30%, 25%, and 14% in 2010, 2020, and 2050, respectively, after the increase in pop- ulation was taken into account.

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TABLE 3 A weekly food list for the final sustainable diet with acceptability constraints and the contribution of food groups to GHGEs of the diet 1

Food groups

GHGEs

Quantity of food

 

Percentage of total

g/wk

Starchy foods, including potatoes

9.4

Pasta, noodles (cooked)

539

Rice (cooked)

189

White bread

553

Whole-grain bread

458

Whole-grain, high-fiber breakfast cereals

147

Other breakfast cereals

70

Porridge oats

168

Non-fried potato products (eg, oven chips)

301

Potatoes (no added fat)

511

Vegetables

14.4

Carrots, turnips (cooked)

140

Tomatoes

434

Peas

175

Brassicas

112

Cauliflower, broccoli, spinach

98

Sweet corn

28

Cucumber

112

Lettuce

133

Mushrooms (fried)

112

Onions (fried)

217

Peppers

252

Fruit

12.8

Apples, pears

497

Bananas

217

Grapes, kiwi, cherries

154

Peaches, nectarines, apricots

301

Raspberries, strawberries, blueberries

203

Fruit juice

630

Dairy products

25.2

Semi-skimmed milk

1813

Other cheese (reduced fat)

182

Yogurt (low fat)

294

Ice cream

77

Meat

17.8

Ham

20

Beef (cooked)

85

Pork (cooked)

85

Chicken (cooked)

182

Fish

11.5

White fish (coated)

147 2

Shellfish

49

Oily fish

91

Nuts and seeds

0.2

Sesame seeds

7

Mixed nuts

28

Beans and legumes

1.4

Beans

70

Baked beans

259

Lentils (cooked)

56

Eggs

2.0

119

High-fat and sweet foods

5.4

Biscuits (sweet and savory)

77

Buns, cakes, pastries

98

Desserts (eg, rice pudding)

203

Low-fat spread

98

Fried, roasted potatoes

147

Crisps, savory snacks

35

Sugar

35

Chocolate confectionery

42

Preserves

42

Total GHGEs (kg CO 2 e/d)

2.43

1 All weights were based on the food as consumed (eg, cooked weight and edible portion). CO 2 e, carbon dioxide equivalent; GHGEs, greenhouse gas emissions. 2 Approximately 56% of the weight is fish.

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TABLE 4 Examples taken from 7-d sample menus for the final version of the healthy and sustainable diet with acceptability constraints

MACDIARMID ET AL

Breakfast

Lunch

Evening meal

Snacks

Day 1

Whole-grain, high-fiber cereal and semiskimmed milk White toast and jam

Vegetable and lentil soup Prawn sandwich

Chicken curry and rice 1 Pita bread

Fruit (berries, apple) Biscuit Milk for hot drinks

 

1

teaspoon sugar 2

Day 2

Porridge Whole-meal toast and low-fat spread Fruit juice

Egg salad sandwich Yogurt

Chili beef and kidney bean tortillas 3 Salad

Fruit (banana, peach) Scone and jam Milk for hot drinks

 

1

teaspoon sugar 2

Day 3

Whole-grain/high fiber cereal and semiskimmed milk Whole-meal toast and low-fat spread Fruit juice

Tomato and red pepper soup Whole-meal roll

Salmon with cream cheese topping New potatoes, broccoli, and carrots Yogurt

Fruit (pear, grapes) biscuit

Small packet of crisps Milk for hot drinks

 

1

teaspoon sugar 2

1 Chicken curry consisted of 91 g cooked chicken (plus mushrooms, onions, and peas). 2 To add to drinks (or equivalent to one glass of diluting juice). 3 Chili beef consisted of 85 g cooked minced beef (plus onions, peppers, kidney beans, and tinned tomatoes).

The final sustainable diet described in Table 3 is only one example of a diet that meets both dietary requirements and

a reduction in GHGEs. It could be remodeled to give many

different food combinations and quantities of food by applying different acceptability constraints and allowing for variation in

individual preferences or cultural practices around food.

Comparison of the sustainable diet with the current UK dietary intake

A comparison of the final version of the sustainable diet (with

acceptability constraints) with the most recent assessment of dietary intakes of adult women in the United Kingdom (2) is shown in Figure 1 . The comparison illustrates the extent to which the diet needs to shift away from meat and high fat and/or sweet foods and toward fruit and vegetables and starchy foods (eg, bread, pasta, rice, and potatoes) to meet both dietary rec- ommendations and reductions in GHGEs. The amount of meat

in the final sustainable diet was 60% of the current intake of all

meat for women in the United Kingdom and 48% of the intake of red meat (2). The proportion of dairy products in the sus- tainable diet was similar to current dietary intakes, but the type of dairy products were lower in fat; in the current UK diet, 24.5% of dairy products came from ice cream, butter, and cream

of dairy products came from ice cream, butter, and cream FIGURE 1. Proportions (by weight) of

FIGURE 1. Proportions (by weight) of food groups in the final sustainable diet compared with the average current intake of women in the United Kingdom (National Diet and Nutrition Survey 2008–2010).

compared with only 5.3% in the sustainable diet, which included more milk than the current diet (62% compared with 42% of the dairy products).

Cost of the sustainable diet

On the basis of the cost of midrange supermarket products in the United Kingdom in September 2010, the cost of the food in the sustainable diet was estimated to be w £29.00 ($46.00)/wk, which is equivalent to w 89% of the current average UK ex- penditure on food. This cost could be reduced further if based on cheaper unbranded products. Included within the cost were small quantities of some basic store-cupboard ingredients, such as herbs and spices. Other products such as tea and coffee were not included in the diet, but the additions of these products would still be within the average UK expenditure on food per week of £ 33.04 (with the exclusion of alcohol) in 2010 (30).

DISCUSSION

This study has shown that changing food choices to meet dietary requirements for health could also help toward mitigating climate change. We have shown that it is not necessary to eliminate meat and dairy products or for changes to be made that would result in an increased cost to the consumer. However, it cannot be assumed that all diets that meet the dietary re- quirements for health will necessarily have lower GHGEs; it is equally possible to create a healthy diet by using a different combination of foods that has a high GHGE. For this reason, it is important that these 2 issues are considered together in the de- velopment of dietary guidelines. There is no single sustainable diet, and the diet described in this study is only one example of an optimized diet. This study highlighted one of the main differences in the ap- proach to recommendations for health and the environment. Di- etary recommendations for health are based mainly on nutrient requirements (which can be achieved through many combinations of foods) (17), whereas the environmental impact is associated with the reduction of intakes of specific foods (eg, meat and dairy). There are synergies here; eg, a reduction in intakes of meat and dairy products could benefit health because, together, these products contribute .50% of the total intake of saturated fatty

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acids in the UK diet (2, 31), and a high consumption of red and processed meat has been linked to cancer (18, 32). However, any reduction in these foods need to be considered in the context of the whole diet to ensure that substitutions made in the diet are appropriate for health (ie, the replacement of them with lower-fat plant-based foods). If the focus is only on a reduction of GHGEs, animal based products could be replaced by cheaper high-fat and/or sugar products, which tend to have lower GHGEs than animal- based products (4, 6). This was recently illustrated in a study that compared a range of vegetarian and vegan diets, all of which had lower GHGEs than the average meat-based diet, but not all of which had an improved nutritional profile that would benefit health (33). The total elimination of meat and dairy foods from the diet would have the greatest impact on reducing GHGEs, but this is likely to be unacceptable for a number of cultural, nutritional, and economic reasons for both consumers and producers. Only 2% of the UK population report being vegetarian, and the consumption of meat and meat dishes in adults in the United Kingdom have increased by almost one-third in the past decade (2). Therefore, the shift in the cultural norm required to achieve a reduction in meat consumption should not be underestimated. The sustainable diet (with acceptability constraints) contained w 60% of the current amount of meat eaten by woman in the United Kingdom. It would be possible to increase the amount of meat in this diet, but this would have to be at the expense of the removal of other foods high in GHGEs. A reduction in the intake of animal products carries risk of a decrease in the intake of essential minerals in the population, if not managed appropriately. The bioavailability of some minerals is less from plant sources than from animal products, and some plants contain compounds that can inhibit the absorption of minerals such as zinc and non-heme iron (7, 34). Because there is evidence of suboptimal intakes of a number of vitamins and minerals, such as iron in women and older girls (2, 18, 28), any recommendation to reduce the consumption of animal products would need to specify appropriate alternative food groups and quantities to ensure the intakes of key nutrients are met. One of the most controversial areas in balancing health and environmental concerns is in relation to fish consumption. Consistent with US dietary recommendations (35) to increase the consumption of fish, in the United Kingdom, consumers are recommended to eat 2 portions of fish per week, one of which should be oily fish (26). Fish is recognized as a good source of protein, and oily fish is one of the few sources of n23 fatty acids, but these recommendations need to be considered in the context of whether there are sufficient global wild-fish stocks to meet these recommendations for the whole population (36). If the health and environmental advice on fish consumption is not har- monized, it will only create more confusion in consumers (37). Some countries have started to produce guides that combine dietary recommendations for health with a reduction in the en- vironmental impact (38–40). Although this is an important step forward, the guides focus on broad food groups and have not considered what every day menus might consist of. To our knowledge, this study is the first to take the general principles for a healthy and sustainable diet to the endpoint of sample menus to show that it is possible to have realistic and affordable diets. In doing so, we have highlighted some of the practical challenges that exist in the combination of recommendations, such as linking food groups (eg, breakfast cereal and milk) and altering recipes for

meat dishes to include more vegetables, beans, or pulses to allow meat-based dishes to be eaten several times a week. Because we took a holistic approach to the diet, we also highlighted where it was difficult to reduce amounts of certain foods. For example, despite the high GHGE associated with dairy products, it was difficult to reduce the amount of milk below the current intakes because, without the use of substitutes, the quantity was necessary to have with the amount of breakfast cereal in the diet (which provided other essential nutrients such as fiber and vitamins). The high-fat dairy products were replaced with lower-fat versions for health benefits, but this can potentially create an environmental problem in terms of waste with the byproducts (ie, cream). It would not be desirable for the cream to simply reenter the diet in the form of low-cost, high-fat foods. Another challenge was the restriction of the sodium content of the diet while trying to increase the amount of complex carbohy- drates by using whole-grain breakfast cereals and bread because these products tend to be high in sodium. Linear programming provides a useful technique for the modeling of diets, but without acceptability constraints that take account of dietary habits and preferences, a realistic diet will not be created, as seen in other studies (27). In this study, an iterative process was used whereby the program was rerun with different upper and lower acceptability constraints for key foods to get the right quantities and combinations of foods to create a set of menus. Although the diet in this study was modeled around UK dietary intakes, the approach used is applicable for use in any country. With the use of the same methodology, diets could be created to meet different dietary or cultural needs or dietary preferences. One of the fundamental elements in the use of this meth- odologic approach was to create a database in which GHGE data and nutrient-composition data were standardized so that they both represented the food as consumed. This method involved the adjustment of published GHGE data to take into account dif- ferences between weights of foods as produced and as consumed (cooked, edible portions). In addition it was important to adjust the data to represent the origins of food consumed in the United Kingdom (imported or domestically produced) because GHGEs are heavily depending on production methods that can vary significantly between countries. A limiting factor was the lack of GHGE data for food and drink products on the basis of a full LCA. In this study, GHGEs were based on emissions for the food production up to the RDC because, at the time of the study, this was the most comprehensive list of GHGEs for foods in the United Kingdom (4). GHGEs after this point in the life cycle of food will vary for different foods depending on the degree of processing, cooking, and waste associated with the product. Future work needs to focus on the contribution of GHGEs at these stages (ie. post RDC) of the life cycle to get data for total GHGEs. This study focused on climate change mitigation (ie, GHGEs), but this is only one element of sustainability. The impact of dietary choices on water use, land use, waste, and biodiversity, as well as social, ethical, and economic issues that threaten future food security, need to be considered in future research and when dietary guidelines are revised. To reflect differences in GHGEs, some of the pictorial dietary guides, such as MyPlate (35) or Eatwell (41), could be subdivided. For example, the nondairy protein section currently includes meat, fish, eggs, beans, and nuts, but in terms of sustainability (in this case, GHGEs), it may be helpful for consumers to know what proportion should be meat.

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MACDIARMID ET AL

In conclusion, this study demonstrates that it is possible to create a healthy diet with lower GHGEs without the elimination of meat and dairy and at no additional cost to consumers. The study highlights some of the differences between dietary guidelines for health and environmental issues that need to be addressed to provide di- etary recommendations that can be communicated in a consistent and coherent way to the public.

The authors’ responsibilities were as follows—JIM, JK, GM, and GWH:

designed the research; GWH, JL, CF, AJ, and JIM: conducted the research; JIM, GM, GWH and JK: wrote the article; and JIM: had primary responsibility for the final content of the manuscript. None of the authors had a conflict of interest.

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