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FReSH insight report SUSTAINABLE AND HEALTHY DIETS: Reviewing existing dietary guidelines and identifying gaps for future action Food Reform for Sustainability and Health (FReSH) thanks the following companies for their contributions:

FReSH Healthy and Sustainable Diets group leaders:

FReSH Healthy and Sustainable Diets group members:

FReSH insight report: Sustainable and Healthy Diets 2 Content 1. The FReSH context 4

2. Understanding existing dietary guidelines 5 5 Country-level dietary guidelines observations 6 Food group-specific observations 9 National advisory committee guidelines that incorporate sustainability 10 Generalizing food-based dietary guidelines 11 Classifying food-based dietary guidelines 3. Defining population targets for improvements 22

4. Consumption data 23

5. Gap identification 25

6. Gap prioritization 32

7. Emerging areas for 36

8. Key takeaways 37

9. Conclusion and outlook 38

FReSH insight report: sustainable and healthy diets 3 1. The FReSH context

FReSH (Food Reform for Sustainability In addition to the need to address For this report, 12 geographically and Health) is a key WBCSD (World societal and environmental diverse countries were selected, Business Council for Sustainable urgency, improving food systems prioritizing those with significant Development) project which emerged also provides a significant global populations and cultural diversity, from our partnership with EAT in business opportunity. While it is from USA to Nigeria. The existing response to the accelerating global acknowledged that every business dietary guidelines and actual problem our planet and people has to promote its own products in consumption data were compared are facing: one-third of the food order to make profits, there are many spanning a range of regions and levels produced is lost or wasted and 40% of examples of how making profits and of development and, in some cases, agricultural soil is degraded, yet 800 “doing good” can be combined. The considering different age segments million people are undernourished potential value for a worldwide food of the population. and food insecurity is generating civil and agriculture system in line with unrest. In addition, 2 billion adults the Sustainable Development Goals We added three countries later on, are overweight, leading to increased (SDGs) is estimated at USD $ 2.3 based on matching priority countries numbers of noncommunicable trillion at current prices. For instance, from other related projects. We diseases and associated healthcare reducing food waste in the value chain collected actual consumption data for costs in both the developing and the is estimated to be worth up to these countries using national survey developed world. Fixing this broken USD $ 405 billion a year by 2030, while data and public databases where system can’t be done through a low-income food markets could see available. The gaps between national piecemeal process. It requires a up to USD $ 265 billion in revenue dietary recommendations and actual full-scale transformation. growth.1 consumption per country and age segment were based on available Where traditionally the focus of national environmental and nutrition efforts to address guidelines. In some cases, we used FReSH aims to develop sustainability issues was on farm to proxy data where actual consumption business solutions that fork, data not been published. From it is now time to look at these : putting consumer these, we have started to identify create healthy, enjoyable from fork to farm diets for all, produced needs and desires at the heart of discrepancies between the guidelines solutions to enable longer term and the consumption data. Where responsibly, within consumption shifts while taking a a local recommendation does planetary boundaries by complete value chain approach that not exist, the consumption data 2030. Acknowledging that links food consumption to production, can be compared to a globalized distribution and agriculture. recommendation taken from business has played a key reasonable averages among the role in the food system To that aim, FReSH members worked various guidelines. both on the positive together in 2017 and early 2018 to analyze state of the art production This work has informed our and the negative side, systems in the world food system recommendations for intervention FReSH members are – covering the full value chain from areas for each country and on a global joining forces to develop consumption to production – level. We acknowledge that in the solutions providing and potential intervention areas. coming years much more information and research will become available healthy, enjoyable diets This report summarizes the findings that will provide more detailed data on for all whilst contributing of the Healthy and Sustainable Diets dietary guidance and gaps to close. to socioeconomic group, which investigated healthy and types based This report only highlights the development and on broad scientific agreement. The situation as it stands in 2017/2018. minimizing (and eventually report is assisting FReSH members eliminating) environmental as a first science-based guide for impacts and waste. possible intervention areas for dietary shifts and business solutions to close dietary gaps to benefit people’s health within planetary boundaries.

1 Business and Sustainable Development Commission. (2017). . Retrieved from: Better Business Better World https://sustainabledevelopment.un.org/content/documents/2399BetterBusinessBetterWorld.pdf

FReSH insight report: sustainable and healthy diets 4 2. Understanding existing dietary guidelines Country-level dietary guidelines observations

We selected 12 globally diverse countries covering Country-level dietary guideline observations each of the key global regions, • Where available, the sustainable food-based dietary guidelines representing a significant all point in the same direction. population size, with both • Energy consumption to match requirements through food urban and rural communities choices, which provide all essential nutrients, is a key point and with various dominant in all guidelines. age groups to have a good • Some countries are more specific with respect to recommended spread of food systems and amounts to be consumed (e.g. meat and ) than others. nutrition habits globally. • In guidelines where there is no focus on sustainability, there is more We inventoried existing dietary focus on consumption of lean meat (and not so much on limiting guidelines related to the intake of (red/processed) meat). 12 identified countries and • For the other food groups there does not seem to be much others, with special interest in difference between guidelines that take the environment into those already incorporating account and the ones that do not (yet). This confirms the results of several modelling/scenario studies in different countries, sustainability-inspired suggesting that according to national dietary guidelines recommendations. would already reduce environmental impact.

Inventory of selected current existing dietary guidelines by country and region Table 1.

Region Country (*selected 12) Type of guideline in place (year of release) USA* Nutrition only, sustainability inclusion rejected (2015) North America Argentina Nutrition only (2016) Latin America Brazil* Nutrition and sustainability (2014) Colombia Nutrition only (2014) Costa Rica* Nutrition only (2011) Mexico* Nutrition only (2013)

France* Nutrition and sustainability (2017) Europe Germany Nutrition and sustainability (2013) Italy* Nutrition only (2003) Nutrition and sustainability (2015) Norway Nutrition and sustainability (2015) Spain* Nutrition with some sustainability aspects (2016) Sweden Nutrition and sustainability (2015) UK* Nutrition with some sustainability aspects (2016)

Qatar Nutrition and sustainability (2015) Middle East Saudi Arabia* Nutrition only (2012)

China* Nutrition and sustainability (2016) Asia India* Nutrition only (2011) Indonesia Nutrition only (2014) Thailand Nutrition only (2001)

Nigeria* Nutrition only (2006) Africa

FReSH insight report: sustainable and healthy diets 5 Food group-specific observations

Meat Fish Dairy

• A recurring common guideline • Countries with sustainability • All sustainability guidelines (for both sustainability and guidelines mostly recommend recommend daily consumption conventional guidelines) is to eat consuming fish one or two times (two to four portions) of low-, a diversity of -rich foods, per week. Countries with a strong low-sugar dairy products. including those from sources. fish culture recommend slightly higher consumption (e.g. Spain and • Some guidelines (Qatar and • There is overall guidance to eat Sweden) with two to three times per Sweden) recommend choosing less fresh and processed meat, week. dairy products fortified with with preference for non-ruminant/ D or plant-based white meat and lean red meat when • Variation in the consumption alternatives fortified with consumed. of low-fat and is calcium and . recommended and two countries • The five countries with the (Germany and Sweden) also give • The conventional guidelines clearest sustainability guidelines guidance on sustainable sourcing. are in line with the above. (China, Germany, Netherlands, Sweden and ) give • The conventional guidelines guidance on type and amounts to are in line with the above. be consumed and are very much aligned, with guidance amounts of no more than 500/600 g cooked meat per week (45–70 g per day). These amounts are not usually split into meat types (red, , etc.).

• The Netherlands indicates maximum red meat consumption of 300 g per week.

• Even in countries where meat is an important nutrient source (such as Nigeria), there is guidance to consume “moderate” amounts of meat.

FReSH insight report: sustainable and healthy diets 6 and , pulses and nuts -rich

• Sustainability guidelines all • Guidance often incorporates • All guidelines agree that recommend consuming five legumes and pulses into the meat/ carbohydrate-rich staples are the portions of fruits and vegetables protein section. foods that should be eaten most daily, equivalent to about 500 g. frequently. • Countries outside Europe tend • Some countries recommend to give clearer and more specific • The sustainability guidelines seasonal fruits and vegetables guidance on consuming legumes/ (mostly European Union) most often (Brazil, Nigeria, Mexico and Spain). pulses on a daily basis. mention switching from refined to wholegrain varieties. • Some countries also recommend • Pulses such as beans, peas types of vegetables – e.g. Sweden and lentils are noted as good • Conventional guidelines focus on prefers high-fiber vegetables as alternative protein sources. consuming adequate amounts they have less environmental of grains – these are mainly from impact and can be stored for • There is infrequent and non- emerging/transitional countries. longer. China recommends that specific guidance on nut dark vegetables, including spinach, consumption, which should tomato, purple cabbage, pak choy, be -free. broccoli and eggplant account for half of vegetables consumed and should appear in every .

• Whole is preferred over fruit juices.

• Conventional guidelines are in line with the above and frequently mention diversity in color.

Food containing and Beverages sugar, salt/

• All guidelines recommend • Most guidelines recommend • Guidance is aligned across choosing liquid, mostly unsaturated limiting products that contain salt all countries sampled. fat containing oils, rather than or the intake of salt to less than saturated solid fats. 6 g per day (or sodium to less than • is the beverage of 2,300 mg per day). preference and consumption of • All guidelines recommend limiting beverages containing sugar the intake of trans fatty acids • Most guidelines recommend should be limited. and saturated fatty acids (SFA). limiting products containing sugar or sugar intake. The US specifies • Alcohol should be consumed • Newer science is challenging that intake of added sugars and in moderation, if at all. putting limits on total fat or SFA should not exceed 10% of . For example, the energy. 2015 Dietary Guidelines Advisory Committee recommends removing the 35% total fat limit for the USA, eliminating it as a nutrient of concern.2

2 Mozaffarian, Dariush & Ludwig, David S. (2015). “The 2015 US Dietary Guidelines: Lifting the Ban on Total Dietary Fat”. . JAMA 2015;313(24):2421–2422. doi:10.1001/jama.2015.5941. Retrieved from: https://jamanetwork.com/journals/jama/article-abstract/2338262

FReSH insight report: sustainable and healthy diets 7 FReSH insight report: sustainable and healthy diets 8 National advisory committee guidelines that incorporate sustainability

National advisory committees help inform General advice the final guidelines • Adopt a less -based and more plant-based diet: less meat and dairy products and more wholegrain products, legumes, and as such provide vegetables, and fruit- and -based meat substitutes. insights into the Reduce food waste (Netherlands). scientific position • Try fair trade products; eat local, seasonal, organic produce; avoid behind country-level waste (Germany, Netherlands). guidelines. However, • Reduce food waste; increase consumption of foods produced with not all elements are respect for wildlife and the environment, e.g. (UK). incorporated into final • Opt for raw (unprocessed) food products, that are in season, rely on short supply chains and environmentally-friendly production versions; therefore, the methods, i.e. with a restriction in inputs (France). statements below are not necessarily in the • Drink tap water instead of bottled water (Germany, UK). official guidelines.

Meat, dairy and Fish Fruits and vegetables other protein sources

• Reduce meat and dairy • Eat one instead of two portions • Aim for five portions of fruits consumption. The importance of fish a week, consider oily fish. and vegetables a day. Choose of dairy (as a source of many This recommendation was seasonal, local produce (including and minerals) to the diet deemed to take sustainability into juices) (Germany). of children means that care needs consideration (Netherlands). to be taken when criteria for • Increase consumption of fruit sustainability are applied. Beans, • Eat less; look for fish with and vegetables, particularly pulses, fish, eggs, meat and other a sustainability label (Germany, seasonal and field grown (UK). : these foods are sources Netherlands). • Buy seasonal and local fruits of protein, vitamins and minerals, • Consume only fish from and vegetables that are not so it is important to eat some sustainable stocks (UK). produced in greenhouses; buy foods from this group (UK). fruits and vegetables with less • Eat less meat (Germany). packaging (France).

FReSH insight report: sustainable and healthy diets 9 Generalizing food-based dietary guidelines

Dietary guidelines from different does not have a recommendation was more often towards health countries often do not cover all for a specific food group but improvement, we considered that components of the diet. Therefore, we consumption data exists, we achieving that guidance would also derived a generalized set of cut-offs interpreted the data using this generic improve environmental sustainability; for ease of interpreting consumption table. We made some modifications the impact icons show where this is data, as shown in table 2. If a country for children. Although the guidance the case.

Generalized set of cut-offs used to interpret consumption data if country-level recommendations do not exist Table 2.

Nutrient Amount General Impact Varies To match requirements (by age, gender and activity) Energy Restrict amount (non-ruminant preferred); Meat - red add more only for nutritional adequacy. No more than 500/600 g cooked meat per week Restrict amount (white preferred); add more only for Meat - poultry (45–70 g per day); nutritional adequacy ideally don’t eat every day Eat less Meat - processed One to three times a week (adults Low-fat, oily fish recommended, sustainably sourced Fish 20–40 g/d, children 5–10 g/d)

Two to four times a day Low-fat, low sugar, potentially fortified with calcium/ Dairy (200–250 g toddlers, adolescent/ vitamin D adult 250–300 g) Plant alternatives fortified

Three to four eggs a week Loose guidance Egg (~180 –240 g) 15–18 g/day Eat salt-free nuts daily Nuts/seeds (7–8 g/day for children)

Daily consumption Legumes and pulses (beans, peas, lentils) daily Non-meat protein Less than 10% of energy Limit, especially in beverages Sugar <35% of energy in total Choose liquid, unsaturated oils; Fats/oils <10% energy from SFA limit trans-fat; reduce SFA ~10% energy from polyunsaturated fatty acids (PUFA)

Fruits/juices Whole fruit preferred over juices (maximum of 150g of juice per day)

Five portions of fruits and Prefer high-fiber vegetables, dark vegetables daily Vegetables vegetables daily, equivalent to ~500g (toddlers 175 g, adolescents 260–350 g)

55% energy (adult: three to five Eat at each meal, switch from refined to wholegrain; Grains/ servings 150 g/day, children: two to at least half of grains to be wholegrains wholegrains three servings 50–100 g/day)

<6 g/day salt (<2,300 mg Na/day) Sodium ~2 liters/day (varies) Preferred beverage daily Water Health Environmental sustainability

FReSH insight report: sustainable and healthy diets 10 Classifying food-based dietary guidelines

We used the 2016 Pyramids, Plates and Planet report by the Food and Agriculture Organization of the United Nations and the Food Climate Research Network as the reference document to classify key countries on the basis of their food-based dietary guidelines (FBDGs).

A total of 83 countries around the world (out of a possible 215) have established FBDGs; but there is a conspicuous lack of FBDGs in low-income countries, especially in Africa where only five countries have guidelines. At the time of compilation of the report, only eight countries had included sustainability considerations in their official FBDGs. However, we note that Spain and the UK have guidance that includes sustainability aspects. These countries are included in the table of countries with sustainable FBDGs.

FReSH insight report: sustainable and healthy diets 11 Food-based dietary guidelines that incorporate sustainability Table 3.

Sweden Netherlands Germany United Kingdom (2015) (2015) (2013) (2016)

Try to maintain energy 2,000 kcal for women, Energy balance by eating just 2,500 kcal for men from all intake the right amount. food and beverages.

Eat less red meat and Eat one or two portions As part of a wholesome Consume no more than 70 g Meat processed meat (no more of meat, poultry, fish, diet, limit meat and (cooked weight) meat than 500 g of cooked eggs, legumes daily, intake to not more than per day. meat a week/70 g per maximum 500 g of 300–600 g per week. White day). meat per week, of which meat (poultry) is more maximum 300 g or red favorable than red meat meat per week. (, ) and low-fat products are preferable.

Eat fish and shellfish two Eat one serving of fish Consume fish once to twice Aim for at least two portions Fish or three times a week. Vary weekly, preferably oily a week, from recognized of fish every week – one of intake of fatty and low-fat fish (e.g. salmon, herring, sustainable sources. which should be oily, such varieties and choose eco- mackerel, eel, trout, as salmon or mackerel. labelled seafood. sardines, etc.).

Chose low-fat, Two or three servings Consume and dairy Have some dairy or dairy Dairy unsweetened products. of dairy products per products daily – preferably alternatives (such as soya Choose soy- or oat- day, including milk or low-fat. drinks and yogurts). Choose based alternatives yogurt or 40 g of cheese, lower fat and lower sugar enriched with minerals and give preference options. and vitamins (vitamin D). to cheeses with high calcium, less fat, less salt.

No guidance. Included in the meat Consume eggs in No guidance. Eggs group; 2–3 eggs per moderation. week.

No guidance. Eat more legumes. Chose mainly plant-based Eat some beans and pulses, Legumes / Eat legumes weekly. foods. they count towards five pulses a day. Pulses such as beans, peas and lentils are good alternatives to meat.

No guidance. Eat daily at least 15 No guidance. No guidance. Nuts grams of unsalted nuts daily.

Eat lots of fruits and Eat at least 200 g of Enjoy five portions of fruit Eat at least five portions Fruits / vegetables (at least 500 g vegetables and 200 g and vegetables daily, as of a variety of fruits vegetables per day). Choose of fruit daily. fresh as possible, cook and vegetables a day. high-fiber vegetables (less for a short time only, environmental impact/ or occasionally, consume longer storage). one serving as a juice or smoothie.

FReSH insight report: sustainable and healthy diets 12 Spain Brazil Qatar China (2016) (2014) (2015) (2016)

Balance dietary intake Avoiding ingesting excessive and physical activity amounts of food and increasing both quantitatively and physical activity are the best ways qualitatively in the context to maintain energy balance. of the recommendations for a healthy balanced diet.

Lean white meats and poultry Try to restrict the amount Choose skinless poultry and lean The appropriate daily intake daily. Red and processed of red meat. cuts of meat. Avoid processed is set at 40–75 g of meat meat consumption should meats (e.g. , luncheon (poultry, pork and beef). be moderate in the context meats). of a , choosing excellent quality products.

Eat two to three servings of No guidance. Eat a variety of fish at least twice The appropriate daily intake fish a week. a week. is set at 40–75 g of fish per week.

Consume two to four servings Milk drinks and yogurts Maintain daily consumption of Consume a variety of dairy a day of quality dairy, with that have been skimmed or low-fat milk and products, equivalent to 300 g of priority to those low in fat and sweetened, colored dairy products. Choose vitamin D liquid milk daily. no added sugar. and flavored are ultra- fortified milk. Choose unflavored processed foods, and as milk, laban and yogurt more often. such should be avoided. For those who do not drink milk or eat dairy products, choose other calcium and vitamin D rich foods (e.g. fortified soy drinks, , chickpeas).

Eggs are an excellent source No guidance. The appropriate daily intake of nutrients and can be is set at 40–50 g of eggs. consumed daily as desired. Give priority to sustainable sources.

Consumption of two to Choose legumes, nuts and seeds Bean products and nuts three servings a week is as alternative protein sources. should be eaten frequently recommended, using culinary Eat legumes daily and prepare in an appropriate amount for techniques that improve their with little or no added fat or salt. energy and essential oils. nutritional value and digestibility.

Nuts and seeds to be Choose unsalted nuts and seeds Bean products and nuts should consumed daily without as part of a healthy snack. be frequently eaten in an added sugar or salt. appropriate amount for energy and essential oils.

Try and eat three servings Eat foods mainly of plant Aim for three to five servings of a Daily vegetable intake should be of fruits and two of seasonal origin. Chose seasonal variety of vegetables every day. in the range of 300–500 g. Dark vegetables (one portion as and locally grown produce. Aim for two to four servings of a vegetables, including spinach, raw vegetables with different variety of fruit every day. Favor tomato, purple cabbage, pak choy, color varieties) every day. whole fruit over juices. broccoli and eggplant, should account for half this amount and should appear in every meal. Fruits should be consumed every day. The daily intake of fresh fruits, excluding fruit juice, should be between 200 and 350 g.

FReSH insight report: sustainable and healthy diets 13 Sweden The Netherlands Germany United Kingdom (2015) (2015) (2013) (2016)

Switch to whole meal. Replace refined Bread, grain flakes, pasta, Base on potatoes, Carbohydrate- Choose wholegrain cereal products with rice, preferably from bread, rice, pasta or other rich staples varieties for pasta, bread, wholegrain products. wholegrains, and potatoes starchy . grain and rice. contain plenty of vitamins, Choose wholegrain where minerals and , possible. as well as phytochemicals. Consume these foods, preferably with low-fat ingredients.

Choose healthy oils Replace , hard Favor vegetable oils and fats Choose unsaturated oils Fats and when cooking, such as and cooking (e.g. canola , oil and spreads and eat in small oils oil or liquid fats fats by soft margarines, and margarines produced amounts. made from rapeseed oil, liquid cooking fats and therefrom). Be aware of and healthy sandwich vegetable oils. hidden fat found in several spreads. meat and dairy products, pastries, sweets, fast food and convenience products. Overall, 60–80 g of fat daily are sufficient. Beans, chickpeas, lentils, More vegetables, less or Eat some beans, pulses, Protein fish, eggs and poultry no meat. Vary between fish, eggs, meat and other sources provide lots of iron and fish, legumes, meat, nuts protein. Pulses such as protein. and egg. Do not eat more beans, peas and lentils are dairy than necessary. good alternatives to meat.

Choose foods with less Limit salt intake to 5–6 Use sugar and salt in Eat foods high in fat, salt Salt / sugar / salt. Use less salt when grams daily. moderation. Favor iodized and sugar less often SFA cooking but choose salt and fluoridated salt. and in small amounts. with iodine when using salt. Hold back on the sweets, pastries, ice creams and other products containing lots of sugar.

Cut back on sweet drinks. Drink as much water Choose water, carbonated Drink plenty of fluids – the Beverages as you like. Limit or non-carbonated, government recommends consumption of sugar- and other beverages low 6–8 cups/glasses a day. containing beverages. in calories. Only rarely Water, lower fat and Do not drink alcohol – drink sugar-sweetened lower sugar or sugar-free or no more than one beverages. Consume drinks, including tea and glass daily. Drink 3 cups alcoholic drinks only coffee, all count. of tea daily and replace occasionally and only unfiltered coffee with in small amounts. filtered.

Other considerations

Livsmedelsverket, National Health Council of the German Nutrition Society (GDE). National Health System. 2016. Reference/ Food Agency, Sweden. Netherlands. 2015. 10 guidelines for a wholesome The Eatwell Guide. Retrieved link “Eating habits and dietary Dutch dietary guidelines diet. Retrieved from www.dge. from http://www.nhs.uk/ guidelines”. Retrieved from 2015. Retrieved from de/fileadmin/public/doc/fm/10- Livewell/Goodfood/Pages/the- www.livsmedelsverket.se/ www.gezondheidsraad. guidelines-for-a-wholesome- eatwell-guide.aspx en/food-habits-health- nl/sites/default/ diet.pdf and-environment/dietary- files/201524edutch_ guidelines/ dietary_guidelines_2015. pdf

FReSH insight report: sustainable and healthy diets 14 Spain Brazil Qatar China (2016) (2014) (2015) (2016)

Consume wholegrain Substitute refined grains (e.g. The daily amount of and cereals and byproducts white bread) with wholegrain potatoes consumed for body energy daily, prioritizing grains breads and cereals. production should be 250–400 g, and derivatives made with including 50–150 g of wholegrains wholegrain flours. Moderate and mixed beans and 50–100 g consumption of sugar of potatoes. The major characteristic and sugary products of a balanced diet is to eat a variety (<10% of energy daily). of foods with cereals as the staple.

Olive oil is recommended In moderation. Use healthy vegetable oils such Oil 25–30 g per day. for daily consumption. as , corn and sunflower in Spreadable fats are moderation. Avoid saturated fat advised for only occasional and hydrogenated or trans-fat consumption. (e.g. , partially hydrogenated ) and foods made with these fats (french fries, commercially baked sweets).

Choose legumes, nuts and seeds as alternative protein sources. Eat legumes daily and prepare with little or no added fat or salt.

Moderate salt intake Limit the consumption of Consume less than 2,000 mg Choose to consume less salt and products high in salt processed foods and avoid of sodium per day, equivalent and fewer fried foods. The daily (structural or added) to avoid ultra-processed foods. to 1 teaspoon or 5 g of salt. recommended intake for adults total intake above 6 g per day. should be no more than 6 g of salt and 25–30 g of . For sugar, the daily intake should be properly controlled and should be less than 50 g, or preferably less than 25 g. For trans fatty acids, the daily intake should be less than 2 g.

Water intake, along with No guidance. Choose water more often than To keep the body well-hydrated, other liquids or foods, other types of beverages. enough water, corresponding to should comprise around Avoid sweetened beverages 7–8 cups (1,500–1,700 ml) for adults, 2.5 liters every day – such as carbonated, energy and should be consumed every day. and increase in case of fruit drinks. The drinking of plain boiled water or physical activity. Moderate tea should be promoted and sugar- consumption or avoidance sweetened beverages discouraged. of alcohol is advised. For adults, the amount of alcohol consumed per day should not exceed 25 g for men and 15 g for women.

Sustainable food: Sustainability in the processes of procurement, transportation, distribution and preparation of food is of great importance in maintaining the and the health of the planet.

Sociedad Española de Ministry of Health of Brazil. Supreme Council of Health of the Wang, Shan-Shan et al. “Dietary Guidelines Nutrición Comunitaria (SENC). 2014. Dietary Guidelines State of Qatar. 2015. Qatar Dietary for Chinese Residents (2016): comments 2016. Guías alimentarias. for the Brazilian Population. Guidelines. Retrieved from http:// and comparisons” Journal of Zhejiang Retrieved from http://www. 2nd Edition. Retrieved from www.fao.org/3/a-az908e.pdf University SCIENCE B v.17(9): 649-656; nutricioncomunitaria.org/es/ http://www.foodpolitics.com/ 2016 Sept. Retrieved from www.ncbi.nlm. noticia/guias-alimentarias- wp-content/uploads/Brazilian- nih.gov/pmc/articles/PMC5018612/ senc-2016 Dietary-Guidelines-2014.pdf

FReSH insight report: sustainable and healthy diets 15 Official food-based dietary guidelines by countries incorporate sustainability aspects Table 4. or have considered doing so

Norway (2015)

Maintain a good balance between the amount of energy you obtain through food and drink and the amount of energy you Energy intake expend through physical activity. Be physically active for at least 30 minutes every day. Choose lean meats. Limit the amount of processed meat and red meat to 500 g per week. This corresponds to two to Meat three dinners and some cold cuts. Choose poultry, lean meat and lean meat products that are low in salt. Limit the amount of processed meat products that are smoked, salted or conserved with nitrate or nitrite, such as . Red meat: from pigs, cattle, sheep and goats. Eat fish for dinner two or three times a week. Recommendation is a total of 300–450 g of pure fish per week. At least Fish 200 g should be oily fish such as salmon, trout, mackerel or herring. Six slices of fish equals about one dinner portion.

Make lean dairy products part of daily diet. Limit the use of dairy products with high saturated fat, such as whole milk, Dairy cream, fatty cheese and butter. Choose dairy products with low fat, salt and little added sugar.

Eggs

Legumes/pulses such as beans and lentils, seeds, spices and herbs are also not included in “five a day”. These often Legumes / have high levels of nutrients and belong in a varied diet. Eat a small handful of unsweetened nuts a day. pulses Wholegrain products, vegetables, fruits, berries, beans, lentils, nuts and seeds are recommended as they are main Nuts sources of carbohydrates and dietary fiber. Vary between different types of vegetables and fruits. Use tomato, onion, leek and garlic. Eat at least five servings (100 Fruits / g) of vegetables, fruits and berries every day. Consume fresh, vacuum-packaged, frozen, and heat-treated vegetables, vegetables fruits and berries. Half of “five a day” should be vegetables.

Potatoes are not included in “five a day” but belong in a varied diet. Potatoes contain more dietary fiber, vitamins Carbohydrate- and minerals than regular rice and pasta. Prefer boiled or baked potatoes. rich staples Choose grain products with high fiber and wholegrain content and low-fat, sugar and salt content.

Choose cooking oils, liquid and soft margarine, rather than hard margarine and butter. It is important to ensure Fats and a good composition in the diet. Replace saturated fatty acids with more beneficial unsaturated fatty acids. A rule oils of thumb is that the smoother the margarine and the butter are at cool temperatures, the more unsaturated fat they contain.

Protein sources

Choose foods with little salt, and limit the use of salt in cooking and food. Processed foods contribute on average Salt / sugar / to 70–80% of salt intake. Therefore, choose low-salt foods and low-salt pre-made meals. SFA Avoid foods and drinks with a lot of sugar every day. Bread, juice and candy are the largest sources of added sugar in the diet. They add a lot of sugar and energy but few vitamins and minerals.

Choose water. Water is required to maintain normal body functions. Normal water covers the fluid requirement without Beverages contributing to unnecessary calories and is therefore the very best drink when thirsty.

Other Vary diet with a lot of vegetables, fruit and berries, coarse grain products and fish, as well as limited amounts of processed considerations meat, red meat, salt and sugar.

Helsedirektoratet. Anbefalinger om kosthold, ernæring og fysisk aktivitet (Recommendations about diet, nutrition and physical activity). Reference/ Retrieved from https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/1150/Helsedirektoratets%20kostr%C3%A5d%20 link engelsk%20IS-2378E.pdf

FReSH insight report: sustainable and healthy diets 16 France (2017) United States (2015) Consume in a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level.

Limit consumption of red meat (maximum of 500g per week) and opt for Consume a variety of protein sources, including lean meats poultry. and poultry. Limit consumption of processed meat (maximum of 150g per week).

Consume twice a week. Include one oily fish. Vary species and sources Consume a variety of protein sources, including seafood. (in particular for consumers of large quantities of these products), to limit exposure to contaminants.

Consume 2 dairy products per day. Recommended portion sizes: 150ml Consume fat-free or low-fat dairy, including milk, yogurt, cheese, for milk, 125g for yoghurt, 30g for cheese. Opt for cheeses that are rich in and/or fortified soy beverages. calcium and low in fat.

Can be consumed as long as their consumption is not an obstacle to Consume a variety of protein sources, including eggs. respecting the other consumption guidelines. Consume at least twice a week. Favor legumes that have been grown using Consume a variety of protein sources, including legumes (beans production methods that reduce exposure to pesticides. Legumes can also and peas) and soy products. be considered as substitutes for meat and poultry. Consume a small handful per day (without added salt). Consume a variety of protein sources, including nuts and seeds.

Consume at least 5 per day. The recommended portion size is 80 to 100g. A healthy eating pattern includes a variety of vegetables from all Consumption increase is recommended, regardless of the initial level of of the subgroups – dark green, red and orange and fruits consumption. No more than one glass of fruit juice per day, which can count (especially whole fruits). as one portion of fruit and vegetables. In that case opt for freshly squeezed fruit. All forms of fruit and vegetables are taken into consideration: fresh, frozen, dried or canned. Favor fruit and vegetables that have been grown using production methods that reduce exposure to pesticides

Consume wholegrain and unrefined cereal products every day, with a Consume grains, at least half of which are wholegrains. preference for non or minimally refined products over refined products. Favor cereals that have been grown using production methods that reduce exposure to pesticides. Only wholegrain unsweetened cereals can be included in this group. Potatoes or refined cereal products can be consumed as long as their consumption is not an obstacle to respecting the other consumption guidelines. Avoid excessive consumption. Opt for rapeseed oil, (high in alpha- A healthy eating pattern includes oils. linolenic acid (ALA)) and , without increasing usual quantities of added fat. Animal oils and fats should be used in limited amounts.

Include a variety of protein sources in nutrient-dense forms. Protein sources include dairy, seafood, meats, poultry and eggs; and nuts, seeds and soy products, and legumes (beans and peas). The recommendation for protein is 5½ ounce-equivalent per day.

Limit intake of salt. Be vigilant regarding the cumulation throughout the Consume less than 10% of calories per day from saturated fats day. Limit adding salt during cooking and eating. Use iodized salt. Limit and from added sugars. Limit trans fats. Consume less than 2,300 consumption of sugar/sweetened products (sweetened beverages, breakfast mg per day of sodium. cereals). Limit the consumption of sweetened and fatty foods (pastries, chocolate, milk-based desserts and ice cream).

The only recommended beverage is water (without restrictions in quantity). Consume alcohol in moderation, up to one drink per day for women Limit the consumption of sugary and sweet tasting drinks limit to one glass and two for men. per day. In this category, opt for fruit juices. Artificially sweetened beverages consumption should be limited. Tea (including herbal teas) and coffee, when not sweetened, can contribute towards water intake. • Ensure that the day’s food intake is overall as close to the guidelines as Focus on variety, nutrient density, and amount. To meet nutrient possible, without each meal being necessarily so. needs within calorie limits, choose a variety of nutrient-dense • Opt for variety in all its forms: diversify the supply sources, procurement foods across and within all food groups in recommended and product origins. amounts. Shift to healthier food and beverage choices. Choose • Avoid excessive portions and intake. nutrient-dense foods and beverages across and within all food • Take enough time to eat and enjoy meals. groups in place of less healthy choices. Consider cultural and • Avoid snacking and particularly the consumption in between meals of fatty, personal preferences to make these shifts easier to accomplish salty and sugary/sweetened products. and maintain. Support healthy eating patterns for all: everyone • Opt for raw (unprocessed) food products that are in season, rely on short has a role in helping to create and support healthy eating patterns supply chains and environmentally-friendly production methods. in multiple settings nationwide, from home to school to work to • is a production method that limits inputs and is a means communities. of minimising exposure to pesticides.

Haut Conseil de la santé publique. 2017. Repères alimentaires. Retrieved from U.S. Department of Health and Human Services and U.S. Department https://www.hcsp.fr/Explore.cgi/Telecharger?NomFichier=hcspa20170216_ of Agriculture. 2015. Dietary Guidelines for Americans 2015-2020, reperesalimentairesactua2017_en.pdf 8th edition. Retrieved from https://health.gov/dietaryguidelines/2015/ guidelines/executive-summary/

FReSH insight report: sustainable and healthy diets 17 Food-based dietary guidelines by countries that do not incorporate sustainability aspects Table 5.

Mexico Argentina Costa Rica Italy Saudi Arabia (2013) (2016) (2011) (2013) (2012)

Moderation, eating Exercise daily. Maintain Watch Match intake of energy (calories) Energy frequency and portion a healthy weight to overall energy needs. Limit intake sizes are important. weight. and be consumption of foods with a high Exercise active. caloric density. Balance energy daily. expenditure with energy intake through physical activity.

The consumption of Poultry two times/week, red Select low- No Limit intake of foods with a high Meat roasted, boiled or grilled meat no more than three fat animal- guidance. content of saturated fatty acids fish and poultry without times/week. When eating sourced and . Choose lean meat. skin and lean meats is meat remove visible fat. foods. Recommended two/three servings/ recommended. Eat only day. One exchange serving = moderate amounts of 60–90 g of red meat or chicken smoked or cured meats or fish. and foods prepared with charcoal or wood. See meat guidance. Fish two times or more No Get unsaturated fatty acids from fish. Fish per week. guidance. Recommended two/three servings/ day. One exchange serving = 60–90 g of fish. *two/three servings of either fish, meat or chicken.

Skimmed or semi Include three portions No Select low-fat milk and milk Dairy skimmed dairy products per day of milk, yogurt or guidance. products. Recommended two/four are recommended cheese. servings/day. One serving = one for adults. cup of milk or laban (240 ml) or 30 g of cheese. Adults should consume Include no more than No Eggs animal products one egg/day, especially guidance. in moderation due for those who do not eat to the high amount enough meat. of cholesterol and saturated fat.

Consume a variety of Mix legumes with cereals Eat rice and No Consume meat alternatives such Legumes / legumes, such as beans, as an alternative to replace beans as guidance. as beans, lentils, fava beans and pulses lentils, peas, etc. meat on occasion. Select the base chickpeas. Recommended variety: legumes such as of daily two/three servings/day. One lentils, soy, beans, peas, feeding. serving = half cup cooked chick peas, and cereals such legumes. as wholegrain rice, oats, maize, wheat, barley, rye, etc.

No guidance. At least once a week eat No Consume unsaturated fatty acids Nuts a handful of nuts without guidance. in the form of nuts. salt (peanuts, nut, almonds, , chestnuts, etc.) or seeds without salt (chia, sunflower, sesame, linseed, etc.).

Consume seasonal and Eat five portions of fruits Eat five Eat more Consume freely or according to Fruits / raw (if possible) fruit and and vegetables of different portions of vegetables, recommended allowance. Consume vegetables vegetables. colors and varieties daily. fruits and tubers and fruits and vegetables of different Eat half a plate of vegetables vegetables fruits. colors and textures throughout at lunch time and dinner and of different the day, both as meals and snacks. two to three fruits per day. colors and Fruits: two/four servings/day; one varieties serving = medium sized apple or daily. orange or bananas or kiwi or half cup of juice (120 ml) or half cup of dried fruits. Vegetables: two/three servings/day; one serving = cup of vegetables or cup of juice or half cup of cooked vegetables.

FReSH insight report: sustainable and healthy diets 18 India Thailand Nigeria Colombia Indonesia (2011) (2001) (2006) (2014) (2014)

Avoid overeating Eat a variety of foods Total food intake should take To maintain a healthy Perform adequate to prevent overweight from each of the five food into consideration a person’s weight, reduce physical activity and . groups and maintain proper level of physical activity. the consumption and maintain a weight. Individuals who do manual of packaged normal weight. work need to consume more products, fast foods, food than those who do soft drinks and sedentary work. sweetened drinks.

Moderate the consumption Eat lean meats regularly. Meat to be consumed To prevent anemia, Eat high-protein of animal foods containing Avoid consumption of meat in moderation. schoolchildren, foods (animal or high fat, SFA and that has visible fat. adolescents and vegetable source). cholesterol. Prefer fish young women to meat, poultry and limit/ should eat offal once avoid organ meats such per week. as liver, kidney, brain, etc.

Eat fish more frequently (at Eat fish regularly. Fish to be consumed Eat high-protein least 100–200 g/week). in moderation. foods (animal or vegetable source).

Choose low-fat dairy foods Drink milk in appropriate No recommendations To favor muscle, bone instead of regular whole fat quality and quantity for on dairy in general guidelines. and tooth health, eat dairy foods. one’s age. Milk is good for eggs, milk and dairy everyone. products daily.

Eggs have several Eat eggs regularly. Eggs to be consumed Eat high-protein important nutrients but are in moderation. foods (animal or high in cholesterol. Limit vegetable source). the consumption to three eggs/week. However, egg whites may be consumed in good amounts.

Eat foods rich in alpha- Eat legumes and pulses Diet should contain as wide a To complement linolenic acid, such as regularly. variety of foods as possible, diet, eat pulses like legumes, green leafy e.g. cereals, legumes, roots/ beans, lentils, peas vegetables, fenugreek and tubers, fruits, vegetables, fish, and chickpeas at mustard seeds. Increase lean meat, local cheese (wara). least two times per consumption of fruits week. and vegetables, legumes, wholegrains and nuts.

Increase consumption of nuts.

Increase consumption Eat plenty of fruits Vegetables and fruits should To improve digestion Eat plenty of fruits and vegetables, and vegetables regularly. be consumed at every meal. and prevent heart of vegetables taking into consideration Liberal consumption of disease, include and fruits. nutrient requirements. It is whatever fruit is in season is whole fruits and recommended that every encouraged. fresh vegetables in individual should consume each meal. at least 300 g of vegetables (green leafy vegetables: 50 g; other vegetables: 200 g; roots & tubers: 50 g) in a day. In addition, fresh fruits (100 g), should be consumed regularly.

FReSH insight report: sustainable and healthy diets 19 Mexico Argentina Costa Rica Italy Saudi Arabia (2013) (2016) (2011) (2013) (2012)

Consume vegetables, Eat more Consume grains with little or no Carbohydrate- fruits, legumes and cereals, added sugar, fat or . Select rich staples wholegrain cereals vegetables, wholegrains or cereals. Limit as a source of fiber. tubers and processed grain consumption. fruit. Nutrient-fortified and enriched cereal should be major sources of calories in the diet. Cereals and bread: six to 11 servings/day. One exchange serving = slice of bread (25 g) or half cup of cooked cereal or breakfast cereal or four to six medium-sized biscuits. Prefer to use vegetable Eat raw oil, nuts and Select Choose Use oven or the barbecue to Fats and oils oils. seeds as . healthy high- cook instead of frying in oil or fat. fats. quality Reduce foods of poor nutritional fats and value such as food enriched with limit the saturated fats and hydrogenated amount fat. Unsaturated fatty acids to eaten. come from vegetables, fish, legumes and nuts. Limit intake of foods with a high saturated fatty acid and cholesterol content. Consume non-caloric Limit the consumption Eat less Consume Limit the intake of salt (sodium Salt/sugar/ sweeteners, and of sugary beverages and sugars and only small chloride) to <2.3 g per day. Use SFA foods high in sugars, foods with high amounts decrease the amounts iodized salt, especially in cities cholesterol, saturated of fat, sugar and salt. consumption of salt. that are not sea side or that are fats, trans fatty acids of salt. Consume in mountain areas. Reduce foods and sodium appropriate of poor nutritional value such in moderation. amounts as those enriched with salt and of sugars, sugars. sweets and sugar- sweetened beverages.

Drink pure water Drink two liters of liquids Drink six to Drink Consume 1.5 liters or six cups Beverages as the main beverage. daily without sugar, eight glasses plenty of water daily. Consume whole prefer simple water. of water daily. of water fruits and vegetables instead every day. of juice. Consume alcoholic drinks only in limited amounts.

Other considerations

SEGOB Diario Oficial Ministry of Health of Ministry of Food and Ministry of Health of Saudi Arabia. 2012. Reference/link de la Federación. 2013. Argentina. 2016. Guías Health of Agriculture Dietary Guidelines for Saudis. Retrieved “NORMA Oficial Mexicana alimentarias para la Costa Rica. Organization from NOM-043-SSA2-2012, población Argentina. 2011. Guías of the United https://www.moh.gov.sa/en/Ministry/ Servicios básicos de salud. Retrieved from http://www. alimentarias Nations. 2003. MediaCenter/Publications/Pages/ Promoción y educación msal.gob.ar/images/stories/ para Costa “Food-based Publications-2013-01-15.aspx para la salud en materia bes/ graficos /0000000817 Rica. Retrieved dietary alimentaria. Criterios cnt-2016-04 _Guia_ from https:// guidelines – para brindar orientación”. Alimentaria _completa_web www.ministerio Italy”. Retrieved Retrieved from http://dof. .pdf desalud.go. cr/ from http:// gob.mx/nota_detalle. gestores_en_ www.fao.org/ php?codigo= 5285372& salud/ guias nutrition/ fecha= 22/01/2013 alimentarias education/ /guia_ food-based- alimentarias dietary- _2011 _ guidelines/ completo .pdf regions/ countries/italy/ en/

FReSH insight report: sustainable and healthy diets 20 India Thailand Nigeria Colombia Indonesia (2011) (2001) (2006) (2014) (2014)

Use a combination Eat adequate amounts Bread, grains and tubers Eat a variety of wholegrains, grams of rice or alternative to be consumed at every meal. of staple foods. and greens. carbohydrate sources. Rice is the of the Thai people. Unpolished rice is more nutritious than highly milled rice. Rice and starchy foods should be consumed daily and in appropriate quantities to maintain energy balance.

Ensure moderate Limit fat intake from animal Be heart-healthy: Limit consumption consumption of edible foods. eat nuts, peanuts of sweet, salty and oils and animal foods and and avocado; reduce fatty foods. use little ghee/butter/ the consumption of Vanaspati. vegetable oils and margarine; and avoid animal fats like butter and .

Minimize the use of Avoid sweet and salty Limit intake of salt, bouillon To maintain a healthy processed foods rich in foods. cubes and sugar. weight, reduce the salt, sugar and fats. Restrict consumption of salt intake to minimum. Use packaged products, fast always iron-fortified iodized foods, soft drinks and salt (double fortified salt). sweetened drinks. To Since, the taste for salt is maintain normal blood acquired, its consumption pressure, reduce the could be restricted from an consumption of salt and early age. Prefer fortified foods high in sodium processed foods. like processed meats, canned foods and packaged products. Drink plenty of water and Drink plenty of water. To maintain a healthy Drink enough safe drink other beverages weight, reduce water. in moderation. Milk is an the consumption excellent beverage for all age of packaged groups as it is a rich source products, fast foods, of nutrients. Drink natural soft drinks and and fresh fruit juices instead sweetened drinks. of carbonated beverages. Prefer tea over coffee. Avoid alcohol. Eat natural and diverse Eat a variety of foods, as indicated in foods. Eat breakfast the plato colombiano every day. Read saludable. To live food labels. Wash healthily, do at least hands with soap 30 minutes of physical and running water. activity every day. Perform adequate physical activity and maintain a normal weight.

National Institute of Nutrition Food and Agriculture Food and Agriculture Organization Food and Agriculture Food and Agriculture of India. 2011. Dietary Organization of the United of the United Nations. 2001. Organization of the Organization of the Guidelines for Indians. 2nd Nations. 2010. “Food-based “Food-based dietary guidelines United Nations. 2018. United Nations. 2014. edition. Retrieved from http:// dietary guidelines – Thailand”. – Nigeria”. Retrieved from http:// “Food based dietary “Food-based dietary ninindia.org/dietaryguidelines Retrieved from http://www.fao. www.fao.org/nutrition/education/ guidelines – Colombia”. guidelines – Indonesia”. forninwebsite.pdf org/nutrition/education/food- food-dietary-guidelines/regions/ Retrieved from http:// Retrieved from http:// based-dietary-guidelines/ countries/nigeria/en/ www.fao.org/nutrition/ www.fao.org/nutrition/ regions/countries/thailand/en/ education/food-based- education/food-based- dietary-guidelines/ dietary-guidelines/ regions/countries/ regions/countries/ colombia/en/ indonesia/en/

FReSH insight report: sustainable and healthy diets 21 3. Defining population targets for diet improvements The next stage of our process was If the target segment did not have later in the process. For Ethiopia, it to select population age segments enough data, we tabulated adult or was possible to get some information of interest in the 12 countries and general population data as available. on toddlers and children, as well as identify scientific literature detailing The list of segments is shown below. adults. For Colombia and Indonesia, studies that demonstrate findings the data gathered is for adults. on respective dietary needs and We added the three Food and Land common food categories with Use Coalition (FOLU) countries excesses or deficiencies. of Colombia, Indonesia and Ethiopia

Selection of population segments by age in 12 countries Table 6.

Region Toddlers (1–2y) Children/adolescents (3–18y) Adults (18–69y) Seniors (70+) (or general population) USA USA USA North America Mexico Mexico Brazil Brazil Latin America Mexico

Italy Italy Italy Italy Europe Spain Spain France France UK UK Spain UK UK

Saudi Arabia Middle East China China India Asia China Thailand

Nigeria Nigeria Africa

FReSH insight report: sustainable and healthy diets 22 4. Consumption data

The information sought on each global databases such as the Global consumption is too high and therefore segment was consumption at food Dietary Database (GDD) or scientific any intervention based on this data group level and in some cases, journal papers. The ideal sources would need to incorporate this individual nutrients. Not all food are country-level dietary intake understanding. Another potential categories and selected nutrients studies, which are also used by the issue is with meat consumption, have data available on actual GDD. In some cases, consumption as studies do not always differentiate consumption for every segment data is unavailable and proxy data is between types of meat or only give red specified; therefore, data gaps are necessary, for instance, we use egg and processed meat, not poultry, such inevitable due to lack of studies or poultry consumption averaged as in the GDD. Recommendations are or accessible information. In some per capita per year at a country level usually made on total meat; therefore, cases, the scientific data targets for some countries. Some data gaps, comparing intake and dietary gap is a sub age group, such as adolescents, such as the split between total cereals not straightforward. In these cases, so this was documented to assist and wholegrain intake, are potentially we only flag clear overconsumption interpretation. misleading. For instance, wholegrain with the knowledge that the is considered underconsumed in EAT-Lancet targets for meat Figure 1 shows the food categories most countries; this data is available consumption in the future will be or nutrients we selected for these on the GDD. However, it is likely much lower and will allow for a stricter data searches. We sourced data from that in some countries, total cereal interpretation at that point.

Food groups and nutrients selected to investigate per country/population segment Figure 1.

Meat (split by red, Energy intake Fish Dairy white and processed)

Pulses/non-animal Egg/egg products Nuts/seeds Vegetables source protein

Cereals (where possible split Fruit and fruit juices Fats/oils/PUFA Protein into refined/wholegrain

Sodium/salt Sugars/sweet products Saturated fatty acids (SFA) Water as beverage

FReSH insight report: sustainable and healthy diets 23 FReSH insight report: sustainable and healthy diets 24 5. Gap identification

Table 7 shows the gaps found in the Overall, we discovered better data data, with a gap being defined as sources for food groups than for the difference between the best nutrients, as can be seen by the data discovered and that of the larger number of grey circles on the actual consumption level. right-hand side of table 7.

Empty blue circles show To note, it is understood that the underconsumption and filled blue GDD will release a new version within circles show overconsumption two years, which would complete based on the level or range given this table for many more foods/ as a target either by the originating nutrients. Most of the data has been country guidance or by the generic collated, so it would be preferable criteria set in table 2. At this point, to supersede what has been we did not judge the distance off found here, as the GDD process is the target; however, if we found more rigorous in data quality and conflicting data or a large variance comparability as they also have based on gender, then this is access to non-public data for this represented by empty green circles. purpose.

Consumption within the target is represented by filled green circles. In some cases, we did not find data after a light search (empty grey circle) or a more in-depth search (filled grey circle).

Some of the dietary gaps identified by food group were similar across the countries and age groups studied:

• For almost all countries, there is low consumption of fruits, vegetables, nuts, seeds and wholegrains. • The results are more diverse for energy, meat, fish, dairy and eggs. • Countries can be loosely characterized into : three groups

Overconsumption of calories and meat, but underconsumption 1) of fish, dairy and eggs.

Reasonable calorie consumption, with overconsumption 2) of meat and/or underconsumption of fish, dairy and eggs in some countries.

Underconsumption of calories and all protein sources. 3) All countries would benefit from diversifying protein sources.

• Some results show distinct differences by age, indicating likely and therefore a more specific segmentation of the population dietary gap.

FReSH insight report: sustainable and healthy diets 25 Heat table showing the simplified gap analysis per country and food group /nutrient Table 7.

Focus Population country segment Energy intakeMeat-red Meat-poultryMeat-processedFish Dairy Eggs Nuts/seeds Fruit-whole

<12y Nigeria A F R I C

(FOLU) Ethiopia 10y

<3y

<3y China Thailand A S I India 1-3y

4-6y Indonesia

Overconsumed Underconsumed Mixed

FReSH insight report: sustainable and healthy diets 26 Fruit-juices Vegetables-totalNon-meat proteinRefined grainsWholegrains/fiberFats Oils/PUFA Protein Sodium Added sugarsSFA Water

Within recommendations No data found after first search No data found after multiple searches

FReSH insight report: sustainable and healthy diets 27

Focus Population country segment Energy intakeMeat-red Meat-poultryMeat-processedFish Dairy Eggs Nuts/seeds Fruit-whole

<3y Italy 3-10y

10-18y Spain <3y

Adolescents E U R O P

France 11-18y

<3y UK

Adolescents

Overconsumed Underconsumed Mixed

FReSH insight report: sustainable and healthy diets 28 Fruit-juices Vegetables-totalNon-meat proteinRefined grainsWholegrains/fiberFats Oils/PUFA Protein Sodium Added sugarsSFA Water

Within recommendations No data found after first search No data found after multiple searches

FReSH insight report: sustainable and healthy diets 29

Focus Population country segment Energy intakeMeat-red Meat-poultryMeat-processedFish Dairy Eggs Nuts/seeds Fruit-whole

Saudi E A S T Arabia M I D L E USA

12-18y N O R T H A M E I C

<12y

Mexico 4-13y

<4y LATIN A M E R I C Brazil

>71y Colombia

Overconsumed Underconsumed Mixed

FReSH insight report: sustainable and healthy diets 30 Fruit-juices Vegetables-totalNon-meat proteinRefined grainsWholegrains/fiberFats Oils/PUFA Protein Sodium Added sugarsSFA Water

Within recommendations No data found after first search No data found after multiple searches

FReSH insight report: sustainable and healthy diets 31 6. Gap prioritization

The gap analysis of 15 countries We planned two waves of The second prioritization wave is comparing dietary guidelines with prioritization, one based on science occurring as part of the Dietary actual intake data demonstrates and a later prioritization oriented Shifts Transformational Goal. We many potential dietary gaps towards FReSH business solutions designed this first wave to look at the between what is consumed and (size of the prize, regulatory gaps from an impact perspective, what is recommended. Therefore, implications, ability to impact). incorporating elements of size of it is necessary to prioritize the most We created a guidance note to population affected, impact on health important and impactful gaps. support the first wave of dietary gap and environment and a sense of how scoring for prioritization within well addressed this gap may already the Dietary Shifts group. be due to other interventions besides FReSH. The prioritization process we created and the first-round criteria we selected can be found in table 8.

Criteria used to make an initial prioritization of dietary gaps found Table 8.

CRITERIA SCORE

Already many impactful initiatives ongoing (>5 found easily) 1 Gap vs current activity 1 Only few impactful initiatives ongoing (2–5 found) 2 Not much ongoing yet (0–1 found) 3

Size of population affected Small: <25% 1 2 with gap (% of country’s total 2 population). Added weight +1 Medium 25–50% for children. Large >50% 3

Benefit of closing gap on Low (gap falls after top 10 for country/not on list) health (based on ranking in 1 3 Global Burden of Disease). Medium (gap falls within top 5–10 for country) 2 Added weight +1 if food group is main source of High (gap falls within top 5 for country) 3 single nutrient.

Low (hard to measure, large uncertainty, or only marginal change reported for >1 environmental impact category 1 + or -* (e.g. climate, , water) in >1 study)

Impact of closing gap on the Medium (substantial changes in >1 environmental impact 2 + or -* environment category in >1 study) 4 (+ or – to indicate whether the High (substantial changes in >2 environmental impact categories 3 + or -* impact is positive or negative) in >2 studies)

* where + indicates a likely avoided impact related to the dietary shift needed to fill the gap, and – indicates a likely increase in impact with respect to the dietary shift needed to fill the gap

In order to minimize bias, at least and potential variance through Therefore, three independent three member companies put each interpretive differences and assessments increased the likelihood dietary gap country list through the standardize assumptions, there of understanding complications prioritization process. Although is still room for scientific debate and allowed discussion towards we designed the guidance for on some of the gaps, especially consensus. the prioritization to minimize bias in terms of environmental impact.

FReSH insight report: sustainable and healthy diets 32 shows that: Table 9 For nearly all countries, energy as they intakes need attention are either too high or too low.

For all countries, increasing vegetable, fruit and wholegrain intakes should have a high as they are generally priority below recommendations.

With regard to animal source foods: • For the China, Colombia, Mexico, Saudi Arabia, Thailand and USA the focus should be on decreasing intake and shifting to more diversity in the intake of animal source foods (from meat to fish, dairy and/or eggs).

• For European countries and Brazil, the focus should mainly to shift to more diversity in the intake of the types of animal-based foods.

• For Ethiopia, India, Indonesia and Nigeria the focus should be on increasing intakes of diverse animal source foods.

FReSH insight report: sustainable and healthy diets 33 Prioritized dietary gaps by country Table 9.

Focus country Vegetables Wholegrains Fruit Energy Fish Legumes (NMP)Nuts/seeds Meat Egg Protein

USA

Mexico

Colombia

Saudi Arabia

Thailand

Eat less energy and animal source foods and change type China

France

UK

Spain

Italy Change type of animal source foods

Brazil

Indonesia

Nigeria

Ethiopia

India

Group/nutrient currently overconsumed Eat more and change type of animal source foods Group/nutrient currently underconsumed

FReSH insight report: sustainable and healthy diets 34

Dairy Poultry Processed meatPUFA Sugar SFA Fat Sodium Water Fruit juicesCarbohydrates /cereals

Highly prioritized gap Lower prioritized gap

FReSH insight report: sustainable and healthy diets 35 7. Emerging areas for nutrition It is understood that country-level Another aspect to consider is that nutrition recommendations can lag food-based dietary guidelines are Moving forward, it the latest science, perhaps by up to related to the average nutrient will be important to a decade in some cases. Therefore, content of those foodstuffs. recognizing new and emerging Emerging science is identifying that challenge the gaps we science is important as these may average nutrient contents of key have identified against supersede current recommendations foodstuffs may be reduced with the in the near future. Earlier in this report, onset of , for example recent science to we mention the recommendation reductions in protein, and iron ensure they are indeed from the 2015 US Dietary Guidelines in food crops grown in a high CO 2 to drop total fat limits in the overall atmosphere.4 Models extrapolating still considered a high US diet. 3 These guidelines also this information for global impact priority and to track recommend dropping cholesterol estimate that an additional 175 million as a nutrient of concern. Other people could become zinc deficient new developments to countries have recently elevated and 122 million protein deficient, and ensure the business certain nutrients in their concern, for 1.4 billion people would be at a higher instance, vitamin D in the UK now has risk of iron deficiency, 5 creating new solutions tackling a reference nutrient intake; in other dietary gaps. dietary gaps remain instances foods listed as a concern relevant and impactful. have been removed, such as giving peanuts and eggs to children 6-12 months old.

3 Mozaffarian, Dariush & Ludwig, David S. (2015). “The 2015 US Dietary Guidelines: Lifting the Ban on Total Dietary Fat”. . JAMA 2015;313(24):2421–2422. doi:10.1001/jama.2015.5941. Retrieved from: https://jamanetwork.com/journals/jama/article-abstract/2338262 4 Myers, Samuel S. et al. (2014). “Increasing CO2 threatens ”. Nature volume 510, pages 139–142 (05 June 2014). Retrieved from: http://www.nature.com/articles/nature13179 5 Smith, Matthew R. & Myers, Samuel S. (2018). “Impact of anthropogenic CO2 emissions on global human nutrition”. Nature Climate Change volume 8, pages 834–839 (2018). Retrieved from: https://doi.org/10.1038/s41558-018-0253-3

FReSH insight report: sustainable and healthy diets 36 8. Key takeaways

• Only eight countries include • The types of guidance for • Diversifying protein sources in sustainability considerations sustainable and healthy most countries would likely be , with certain countries in their official food-based consumption vary by country beneficial, ; but Spain, examples being to adopt a less exceeding their animal source dietary guidelines and the UK have general animal-based and more plant- protein recommendations (e.g. guidance that includes some based diet; to reduce food waste Mexico, USA) and others that sustainability aspects. and spoilage; to try fair trade would benefit from an increase products; to eat local, seasonal, in animal source foods (e.g. • For all countries, organic produce and to increase Ethiopia, Nigeria). Therefore, vegetables, fruit, nuts, the consumption of foods we have identified protein seeds and wholegrain produced with respect for wildlife diversification as a priority gap. intakes are generally below and the environment. and have recommendations been identified as priority gaps. • In most countries, there

is either an over- or . underconsumption of energy

FReSH insight report: sustainable and healthy diets 37 9. Conclusion and outlook

We recognize that there are many In the broader FReSH project, Conclusion dietary gaps across the globe. In teams working on the three other This report summarizes the 2017 the future, it is understood that both Transformational Goals will also be findings and conclusions of the the Global Dietary Database and the developing solutions to complement FReSH Healthy and Sustainable Diets EAT-Lancet report will provide more the Dietary Shifts Goal. group. It currently assists FReSH analysis; but the early identification industry members as a guidance for and prioritization of gaps was an These goals are to: possible intervention areas for dietary important element of the FReSH shifts and business solutions to process to identify where industry • Assess the true cost of food close dietary gaps to benefit people’s can have the most impact. • Reduce health within planetary boundaries. • Address nutrition security in supply chains. Dietary guidelines and dietary advisory committees at the country Outlook By working together, FReSH can level can and do incorporate FReSH recognizes the significant explore system-level change via sustainability in some manner challenge of shifting diets. We are these four transformational goals alongside nutrition and health. just at the beginning of identifying towards our ambition to achieve By 2017, only eight countries had how industry can play a positive “healthy, enjoyable diets for all, included sustainability considerations role. We created the overarching produced responsibly, within in their guidelines, with several others Transformational Goal of “Dietary planetary boundaries by 2030.” publishing updated guidance that Shifts” to address this topic fully. includes some sustainability aspects. It can be separated into three The types of guidance for sustainable streams: improving nutrition in and healthy consumption include packed products (reducing sugar, advice to adopt a less animal-based salt and fat, increasing fortification), and more plant-based diet; to reduce sustainable and healthy protein food waste and spoilage; to try fair production and consumption; and trade products; to eat local, seasonal, addressing the underconsumption organic produce; to increase the of fruits, vegetables, nuts, seeds and consumption of foods produced wholegrains. FReSH is now planning with respect for wildlife and the country-level pilot programs with the environment; to look for logos for aim of testing ideas and interventions. sustainable use of resources; and The understanding gained from this to drink tap water instead of bottled step will guide where and how to act water. in the longer term.

When comparing actual We will run pilot projects in several consumption data found in the countries, each tackling a different literature with the country level dietary gap as an entry point, or generalized recommendations, translating this report into action we found several patterns. Almost on the ground. These projects will all countries do not consume also build on the science-based enough fruits, vegetables, nuts and targets for healthy and sustainable seeds and wholegrains. In terms of food systems taken from the calories and protein, the countries independently researched work can be loosely characterized into on planetary boundaries by the three groups: 1) overconsumption EAT-Lancet Commission, to be of calories and meat; 2) reasonable published early 2019. FReSH member calorie consumption, with companies will collaboratively build some meat reduction; and 3) scalable, science-driven business underconsumption of calories and solutions for these pilot markets, meat/protein. All countries would working from fork to farm across the benefit from diversifying their whole value chain. protein sources.

FReSH insight report: sustainable and healthy diets 38 Acknowledgements

Authors Disclaimer About the World Business This report was compiled by the Karen Cooper Council for Sustainable Sustainability Group Leader member companies working within Development (WBCSD) Nestlé Research the Healthy and Sustainable Diets WBCSD is a global, CEO-led group of FReSH as a practical guide organization of over 200 leading towards identifying dietary gaps Jacobine Das Gupta businesses working together Director of Brighter Living Solutions that FReSH could tackle from an to accelerate the transition to a DSM industry perspective. The information sustainable world. We help make our contained in this report is accurate member companies more successful to the best of FReSH’s knowledge Maaike Bruins and sustainable by focusing on Senior Scientist in Nutrition at the time of compilation in 2017. the maximum positive impact for DSM This report therefore is not meant to shareholders, the environment and be used, nor should it be used, as a societies. standalone source of information on Mariska Dötsch Research Scientist dietary gaps or to supersede other Our member companies come from more comprehensive reports on this all business sectors and all major topic by other parties. economies, representing a combined revenue of more than USD $8.5 Sheila Wiseman This report is released in the name R&D Nutrition Project Manager trillion and 19 million employees. Our of WBCSD. Like other WBCSD Unilever Global Network of almost 70 national publications, it is the result of a business councils gives our members collaborative effort by WBCSD staff, unparalleled reach across the globe. Agnès Martin experts, and executives from member Health and Diet Advocacy Director WBCSD is uniquely positioned to companies. A wide range of members Danone work with member companies along and experts reviewed drafts, thereby and across value chains to deliver ensuring that the document broadly impactful business solutions to Manfred Eggersdorfer represents the perspective of the Senior Vice President, the most challenging sustainability WBCSD membership. It does not Nutrition Science issues. mean, however, that every member DSM company and partner agrees with Together, we are the leading voice every word. of business for sustainability: united by our vision of a world where more Other contributors than nine billion people are all living (WBCSD) well and within the boundaries of our Emeline Fellus (WBCSD) planet, by 2050. Alison Cairns (WBCSD) Elisabeth Petraki www.wbcsd.org The authors would like to thank the companies participating in the Healthy Follow us on Twitter and LinkedIn. and Sustainable Diets group and their representatives who greatly enhanced the outcome of the report Credits with their valuable contributions, as Copyright © WBCSD October 2018 well as Dr Fabrice DeClerck, Science Director, EAT and Maya Rebermark, Communications Manager, EAT, for their contributions to the report.

FReSH insight report: sustainable and healthy diets 39 World Business Council for Sustainable Development Maison de la Paix Chemin Eugène-Rigot 2B CP 2075, 1211 Geneva 1 Switzerland www.wbcsd.org