Sustainable Diets: Definition, State of the Art and Perspectives REVISÃO REVIEW for a New Research Agenda in Brazil

DOI: 10.1590/1413-81232021265.09742019 1833

Sustainable diets: definition, state of the art and perspectives REVISÃO REVIEW for a new research agenda in Brazil

Dietas sustentáveis: definição, estado da arte e perspectivas para uma nova agenda de pesquisa no Brasil

Rozane Márcia Triches (https://orcid.org/0000-0002-4460-4821)1

Abstract It is an integrative literature review Resumo Trata-se de revisão de literatura inte- to discuss the emergence and construction of the grativa para discutir o surgimento e construção da definition of sustainable diets, to bring the cur- definição de dietas sustentáveis, trazer o panora- rent panorama of what has been studied about it ma atual dos estudos sobre o tema e apontar para and to point to a new research agenda in Brazil. uma nova agenda de pesquisa no Brasil. As buscas The searches conducted between April and July foram realizadas entre abril e julho de 2018, nas 2018, were carried out in the databases Science bases de dados Science Direct, Pubmed, Periódicos Direct, Pubmed, Periódicos Capes, Google Aca- Capes, Google Acadêmico, Banco de Teses, além demic, Banco de Teses, in addition to the use of do uso do método snowball, resultando em 365 the method snowball, reaching 365 articles analy- artigos analisados. A preocupação com dietas sus- zed. The concern with sustainable diets is related tentáveis está relacionada ao redirecionamento do to the redirection of the dominant food system sistema alimentar dominante no alcance de metas in the achievement of environmental and health ambientais e de saúde, considerando a cultura e goals, considering the culture and the economy. a economia. Os principais focos de interesse dos The main focus of the articles were: theoretical ef- artigos foram: esforços teóricos para conceituar o forts to conceptualize what are sustainable diets; que são dietas sustentáveis; análise de diferentes analysis of different types of diets; factors involved tipos de dietas; fatores intervenientes nas escolhas/ in consumers’ choices/behaviors; size of food pro- comportamentos dos consumidores; dimensão da duction; of health; of the economy; culture and so- produção de alimentos; da saúde; da economia; ciety; policies and governance; and discussion on da cultura e sociedade; políticas e governança; e the methodologies used to measure and analyze discussão sobre as metodologias utilizadas para the different aspects of sustainable diets. In Bra- medir e analisar os diferentes aspectos das dietas zil, only 19 papers were found, which points to the sustentáveis. No Brasil foram encontrados apenas gap in this area of research and the need to crea- 19 trabalhos, dentre os quais, nove artigos, o que 1 Programa de Pós- Graduação Stricto Sensu te this agenda of studies in the country, given its aponta para a lacuna nesta área de pesquisa e a em Agroecologia e importance for public and environmental health. necessidade de criar esta agenda de estudos no Desenvolvimento Rural Key words Food, Sustainability, Diets, Public he- país, dada sua importância para a saúde pública Sustentável, Universidade Federal da Fronteira Sul. alth, Food system e ambiental. Rua Edmundo Gaievski Palavras-chave Alimentação, Sustentabilidade, 1000, Centro. 85770-000 Dietas, Saúde Pública, Sistema alimentar Realeza PR Brasil. [email protected] 1834 Triches RM Triches Introduction Considering that in the medium and long terms, food systems will be under pressures such The predominant food system has reached high as population growth, climate change, increased levels of productivity, but its consequences have competition for natural resources, urbanization called into question its efficiency in relation to and globalization of diets, and that many of sustainability and the population’s health. These their effects will be negative, it is essential that consequences can be identified in the world and strategy makers ponder the consequences of all in Brazilian population through nutrition prob- these factors of change regarding their own food lems and noncommunicable diseases, social and systems5,6. In the Brazilian case, this concern is economic issues associated with food production even more emblematic, since all the aspects men- and environmental problems. tioned above would be aggravated and the efforts Regarding food and nutrition of the Brazilian made to leave the Hunger Map could be lost. population, the nutritional transition has been Studies go further into this matter as the cur- observed in the last decades, which is character- rent food production system accounts for 20 to ized by an increase of overweight and noncom- 30% of greenhouse gas emissions; about 24% of municable chronic diseases, also associated with the arable land has some type of soil degradation a declining prevalence of undernutrition. In this depending on the agricultural model adopted; context, obesity was consolidated as a nutritional the use of land for monoculture and livestock issue associated with the high incidence of car- farming has led to deforestation and loss of much diovascular diseases, cancer and diabetes, thus of the biodiversity; and water has been contami- influencing the morbidity and mortality profile nated, including sea water, leading to imbalances of the populations. The latest data released by in the marine environment. However, not only Brazilian Institute of Geography and Statistics does food production generate environmental (IBGE)1 on the Brazilian Household Budget Sur- problems, but also the processes included in the vey (2008-2009) indicate that around 50% of the supply chain, such as transport, processing and adult population and one third of the child pop- preparation of food, as well as wastage and waste ulation are overweight. generated7-9. With regard to production, a productive Given this context, it is necessary to rethink model has been strengthened in the last decades, the consumption of food and especially the diets. which disseminates practices and offers types of What and how much we eat impacts directly on food that are closely linked to this health scenar- what and how much we produce, and therefore io. This model is based on intensive, mechanized it is necessary that diets be more sustainable and agriculture, with increased use of chemicals and also healthy. In Brazil, the field of Nutrition and food processing, long supply chains, standardiza- even other areas of knowledge have not explored tion of food habits and with a great interference this type of approach yet and barely addresses of the international trade in the domestic food matters related to the agri-food model and its in- supply. Its influences do not only concern food fluence on Brazilian people’s diets and vice versa. and nutrition issues, but also environmental and Given the importance of this theme and the social consequences, such as the marginalization need to bring the discussion of sustainable diets of a large numbers of family farmers and the un- to Brazil (so that the academy can subsidize pol- sustainable use of natural resources2,3. icies and actions that meet the problems men- According to the Sustainable Development tioned above), this article proposes, based on ex- Indicators4 by IBGE, Brazil is among the ten isting literature: i) to discuss the emergence and largest emitters of greenhouse gases to the atmo- construction of the definition of sustainable di- sphere and have other problems like: the destruc- ets; ii) to provide the current panorama of what tion of natural vegetation, especially the Amazon has been studied on this topic worldwide and iii) deforestation and burning in the Cerrado; the de- to point out a new research agenda in Brazil. forested area accounts for almost 20% of the orig- inal Amazon forest area; lack of basic sanitation remains a serious socio-environmental problem, Methodology also causing alarming rates of contamination of rivers by household and industrial effluents; and This research is characterized as an integrative the number of Brazilian species threatened with literature review. This type of review enables extinction has been increasing, which demon- analyses that extrapolate the synthesis of the re- strates the destruction of natural areas. sults of the primary studies, covering other di- 1835 Ciência & Saúde Coletiva, 26(5):1833-1846, 2021

mensions of the research, and has potential for Pubmed, 72 in Bireme. With the snowball meth- the development of new theories and research od another 124 records were found. The total was problems10. It was composed of six phases in the 2790 materials, but of these, 809 were duplicates elaboration process: elaboration of the guiding and 1616 were excluded after screening by ex- question (what are sustainable diets and what clusion criteria. The final number of 365 arti- has been studied about it?), literature search, cles was obtained, written mainly after 2010, as data collection, critical analysis of studies and Graphic 1 shows. enclosed documents, discussion of data and pre- These 365 articles were mostly developed by sentation of the integrative review. European researchers, especially in the United Based on the guiding question, criteria for Kingdom (77 articles) which, together with the the selection of studies and search strategy were Atlantic countries of Northern Europe, is the defined. The searches were carried out in the Sci- region that has most published research on sus- ence Direct, Medline/ Pubmed, Periódicos Capes, tainable diets (Graphic 2). The region with the and Google Academic databases (uniterms in En- second largest number of publications, also in glish) and Scielo and Banco de Teses da Capes Northern Europe but connected to the Atlantic databases (uniterms in Portuguese). In addition, Ocean through the North Sea, includes Nether- the snowball method was used, which consists lands, Belgium and Germany, out of which the in reviewing the references used in the studies Netherlands is the most prominent, with 52 pub- found when searching the databases. lished articles. In Latin America there were nine Uniterms ‘sustainable diet’ were used in En- articles, five of them from Brazil, one from Ar- glish and Portuguese, in singular and plural gentina, one from Chile, one from Peru, and one forms, and full articles published in English/ from Uruguay. Portuguese with no limit for date of publication, According to the literature and by seeking to country of study or area of knowledge were in- organize the information, nine main foci of stud- cluded. Articles that did not explicitly address the ies on sustainable diets were formulated: 1) the- issue, did not answer the research question and oretical efforts to conceptualize and discuss what those that were editorial were excluded. There- sustainable diets are; 2) analysis of different types fore, the title and abstract of the publications of diets, meals, culinary preparations, foods and were read and the studies that did not meet the nutrients and their interrelations, mainly with research requirements were removed. Papers the environment dimension, but also with other published in Brazil, in Portuguese language, were dimensions; 3) consumption – factors that inter- analyzed separately to obtain a clearer view of vene in consumers’ choices/behaviors and which what has been studied in the country. recommendations or dietary guidelines are for- Afterwards, the documents were fully ana- mulated by countries to try to guide them to- lyzed to explore the objectives of the study, the wards sustainable diets; 4) the agriculture dimen- methodology used and the results, by seeking to sion, or the food production dimension – how identify and systematize what has been studied food has been produced, processed, transported, within the sustainable diets theme and how this wasted; 5) health dimension; 6) economic di- theme has been developing in recent years. This mension; 7) socio-cultural dimension; 8) policies search was conducted between April and July and governance related to sustainable diets and 2018. the food system; 9) discussion about the methodologies used to measure, analyze, and evaluate the different aspects of sustainable diets. These Results and discussion foci can be seen in Table 2.

State of the art review on sustainable diets Understanding what sustainable diets are

By analyzing the number of published stud- Given the number of studies found, firstly we ies using the term ‘sustainable diet(s)’ at some sought to identify how the concept of sustainable point in their body, we found that this theme has diets has been constructed. The first publica- gained prominence over the last eight years, as tion to use the term sustainable diets was writ- can be seen in Table 1. By searching major da- ten by Gussow and Clancy in 1986, published in tabases, the following amount of published ar- the Journal of Nutrition Education with the title ticles were found: 1805 in Google Scholar, 368 “Dietary Guidelines for Sustainability”11. The au- in Science Direct, 346 in Periódicos Capes, 75 in thors argued that it was no longer sufficient for 1836 Triches RM Triches Table 1. Number of published articles including the term ‘sustainable diet(s)’ in bibliographic databases from 1970 to 2018. Data base Publication Capes Pubmed Science Direct Google Schoolar Years 1970-1980 0 0 0 0 1981-1990 1 0 5 3 1991-2000 9 0 24 26 2001-2010 26 3 44 196 2011-2018 310 84 295 1580 Total 346 87 368 1805 Source: The authors.

70 64

60 52 48 50 47 42 40 40 34

30 21

Number of papers Number 17 20

0 Until 2011 2012 2013 2014 2015 2016 2017 2018 2010

Year

Graphic 1. Number of papers until 2018 on sustainable diets.

nutrition education to provide information on uses human and natural resources to produce the relationship between human health and food food and fiber in a preservative way, that is, in choices because educated consumers needed to a way that does not waste finite resources such make dietary choices that not only improved as soil, water and fossil fuel. In another study their own health but also contributed to the published in 1989 by Herrin and Gussow12, the protection of natural resources. Thus, they sug- authors propose to discuss a sustainable regional gested the term ‘sustainable diets’ by relating it to diet, advocating the idea of consumption of lo- ‘sustainable agriculture’, given that sustainability cally produced foods. would be associated with anything able to remain In the 1990s, Feenstra (1997)13 and Peters within natural systems in the foreseeable future. (1997)14 took up the idea that building a sustain- Thus, sustainable agriculture is agriculture that able and secure food system begins by reconnect- 1837 Ciência & Saúde Coletiva, 26(5):1833-1846, 2021

African Countries 7 Hungary, Serbia, Croatia, Slovenia e Romania 7 Latin America Countries 9 Austria, Switzerland, Luxembourg 18 Asia Countries 27 Australia, New Zealand 36 USA, Canada 60 Portugal, Spain, Italy, Greece, Malta e Turkey 66 Norway, Finland, Denmark, Sweden 66 Netherlands, Belgium, Germany 92 UK, Ireland, France 103

0 20 40 60 80 100 120 Number of papers

Graphic 2. Number of articles published by world regions on sustainable diets.

Table 2. Systematization of the articles found in nine foci of study and their respective subdivisions on sustainable diets until 2018. Publications Research Focus Subdivisions of themes within each study focus number Theory Publications about theoretical discussions on sustainable diets Total 22 Diet Mediterranean 14 Vegan/vegetarian/ovo-lacto vegetarian 14 Diets of the emerging contries (Argentina, Brasil, China, Índia etc.) 11 Nordics 8 Dutchs 8 Other types of the diets/menus 46 Analyse of the deals e recipes 5 Consumption meat 24 Consumption dairy 10 Other foods 17 Proteins 5 Calories, fats 7 Micronutrients and others substancies 6 Total 146* Consumption Perceptions, beliefs, ideals, motivations, preferences 29 Behavior, lifestyles, habits, tastes 20 Awareness, information, knowledge, education 8 Demographic and psychological characteristics (gender, socioeconomic 7 level, age) Strategies and interventions (dietary guidelines) 21 Total 72* it continues 1838 Triches RM Triches Table 2. Systematization of the articles found in nine foci of study and their respective subdivisions on sustainable diets until 2018. Publications Research Focus Subdivisions of themes within each study focus number Agriculture Livestock (meat, dairy, fish, eggs etc.) 16 Local, regional, transport and supply 11 Diversification and sazonality 10 Organics 10 Waste 9 Processing and development of the news products 5 Pesticides and fertilizers 1 Others (vitiviniculture, rural tourism, soil) 3 Total 63* Health Noncommunicable diseases 2 Obesity 3 Nutrition 2 Nutritional deficiencies 2 Total 7* Economy Taxs, subsidies 5 Industry/retail/services 4 Prices, costs 3 Rebound effect 2 Total 14 Sociocultural Social actors 3 Community/social inclusion 3 Ethic/moral 2 Gourmet 1 Total 9 Policies e governance Policy 9 Governance 2 Total 11 Metrics, measures Life cycle analysis 8 and models to analyse Development of the others metrics and indexes 8 sustainable diets Analysis of the others existing metrics and indexes 6 Total 21* Total 365 *The total number is less than the sum of the parts, since some studies have more than one focus of analysis.

Source: The authors.

ing local food systems with the construction of health and agriculture, which practically did not a healthy community, bringing attention to the exist by then. Since the 2000s, studies on this have term Environmental Nutrition. This is related become more frequent, given the emergence of to the idea that food choices have consequences food problems, coupled with environmental, so- and can make a difference in the way natural re- cial and economic issues related to food. These sources are used. Wahlqvist and Specht (1998)15 issues have equipped several branches of science use the term Econutrition to allude to the impor- to seek a better understanding of the relation- tance of food variety and biodiversity for health ship between production and food consump- and the environment. tion. Food production, which had been thought These authors and studies began a discussion through the bias of productivism until then, in the 1980s and 1990s involving the relation- starts to be discussed due to its consequences ship between diets and food systems, or between as an unsustainable model. On the other hand, 1839 Ciência & Saúde Coletiva, 26(5):1833-1846, 2021

food-related diseases have increased significant- oretical articles found, these five dimensions or ly, and the environment has been showing its determinants must be understood as being inter- limits, evidencing the need for changes in the connected, and by taking up some authors’ argu- population’s eating habits and the consumerism ments7,17-21, they correspond to a set of questions. culture. Thus, consumption and diets began to Therefore, the concept of sustainable diets be thought as important links of a sustainable suggests that they must be constituted to have the food system in a perspective where there is an potential to recalibrate the current food system, interaction with other concepts, as sustainability, for this system compromises the ability to pro- sustainable development, sustainable food con- duce food in the future and can have irreversible sumption and sustainable nutrition. effects on the ecosystem and health. Within this sustainability debate, in 2010, FAO coined the concept of ‘Sustainable Diets’: Studies on different types of diets They are those diets with low environmental and their components impacts which contribute to food and nutrition security and to healthy life for present and future Out of the 365 articles found, 146 were di- generations. Sustainable diets are protective and rectly related to the study of different diets and respectful of biodiversity and ecosystems, cultur- their compositions (meals, menus, preparations, ally acceptable, economically fair and affordable; foods, nutrients). All these articles, without ex- nutritionally adequate, safe and healthy; while ception, relate diets to the environmental dimen- optimizing natural and human resources.16 sion. The most commonly found analyses refer However, for Meybeck and Gitz17, this defi- to gases emission or to a set of environmental nition does not involve the food system directly, factors assessed by the life cycle (compilation of and therefore the authors propose another defi- evaluations of inputs, outputs and potential envi- nition: ronmental impacts of a product system through- A sustainable diet is a diet that contributes out its life cycle). However, there are studies fo- to good nutritional status and long term good cusing on certain environmental issues, such as health of the individual/community, and that the impact on land use (12 articles) and water use contributes to, and is enabled by, sustainable (five articles). It should be noted that the size of food systems, thus contributing to long term agriculture also appears implicitly when environ- food security and nutrition. mental analyses are carried out, referring to the The authors argue that this concept explicitly environmental impact of production, transpor- links the two concepts and that it turns sustain- tation, processing, land use, water etc. able diets not only into a concept, but also into The other dimensions of sustainable diets a goal: to transform the food system to achieve are also considered in some studies, such as the food and nutrition security. For Mason and health dimension, in which analyses aiming to Lang18, the term refers both to health and envi- identify the diets that best respond to nutritional ronment and encapsulates a multiplicity of goals quality coupled with environmental impact (46 for healthy eating in order to cause the lowest en- articles) stand out. Works that added to the anal- vironmental impact, which is aligned with other yses including environment, health and econo- cultural and socioeconomic goals. my totaled 14 articles, and there were five works Combining these concepts and considering which analyzed environment, health and the so- that a sustainable food system is based on four ciocultural dimension together. There were only domains - health, economy, society and the en- five articles with analyses under scrutiny of all vironment19, sustainable diets interact with these dimensions (health, environment, socio-cultural, dimensions when they are said to be culturally agriculture, economic). acceptable (social dimension), fair and afford- One of the most analyzed diets in the studies able (economic dimension), safe, nutritious, (14 articles), carried out mostly by Italians and and healthy (health dimension), protective and Spanish researchers was the Mediterranean Diet, respectful of biodiversity and ecosystems (envi- which is considered an example of a sustainable ronment). In addition to these dimensions, the diet for its nutritional quality along with its low definition by FAO and other authors who have environmental impact, respect for culture and been studying this theme20,21 add agriculture as a tradition and economic viability. Another group fifth determinant or a fifth dimension. of diets evaluated in 14 studies included diets In order to try to understand the complexity with reduced use of meat (e.g. plant-based diets) of what a sustainable diet is, according to the the- or no use of meat but including eggs and milk 1840 Triches RM Triches (e.g. ovo-lacto vegetarian diets) and diets which tives also protect against cardiovascular diseases, exclude any type of product of animal origin (e.g. since reducing meat consumption would also re- vegetarian and vegan diets). duce the consumption of animal fats and, there- Some diets associated with specific consump- fore, increase the consumption of vegetables and tion characteristics from each country or group fruits. In these discussions between nutritional of countries were also investigated. The Nordic quality versus environmental impact, in addition and Dutch diets stand out, with eight studies to macro and micronutrient analysis, there is also each. Emerging countries like China, India, Brazil room for research on chemical residues in food, and Argentina have 11 articles in total. However, which may cause endocrine disorders, various it should be noted that these studies are predom- types of cancer and noncommunicable diseases. inantly from Europe; out of the 53 articles with On the other hand, especially in studies focused this focus, 33 (62%) are from Europe. It is worth on organics, phytochemicals have been included noting that some of these studies analyzed the in the discussion as important substances for the nutritional recommendations of their country to prevention of those diseases. compare them with the usual diets or with other dietary patterns, or they conducted modeling of Consumption and sustainable diets diets which brought together nutrition and environment goals in optimal diets. In this regard, One of the core topics of sustainable diets is Behrens et al22 carried out an environmental im- the dietary patterns and foods we choose to make pact analysis of the nutritional recommendations up our daily menu, but another important re- of 37 countries, identifying whether healthy diets search question is to understand consumers’ mo- are compatible with sustainable diets. tivations/behaviors. Seventy-two articles seek to Within this dietary assessment, few stud- identify perceptions, beliefs, ideals, motivations, ies (five) have been dedicated to the analysis of consumer preferences; their levels of awareness, meals – homemade, semi-prepared, ready-to-eat, information, knowledge, education; behaviors, school snacks or specific preparations – identi- different lifestyles, habits, tastes; and the demo- fying which ones impact more or less the envi- graphic and psychological characteristics of peo- ronment. ple (gender, socioeconomic status, age), relating On the other hand, the most assessed foods in these aspects to acquisition or consumption of the studies were meats and dairy products, con- certain foods. sidering their high impact on the environment. Some of these studies identify the consumer’s This largely explains the amount of analyses profile, reasons and difficulties in adhering to -di of diets such as vegan/vegetarian/plant-based/ ets considered to be more sustainable, such as less Mediterranean, as explained above. Studies iden- meat, fewer dairy products, with more environ- tifying the environmental impact of meat con- mentally-friendly food choices, organics, local sumption total 24 articles, and analyses of the products, and others. Therefore, they consider consumption of dairy products total ten articles. that one of the great challenges posed when con- Considering the current interest in identifying sumers choose sustainable diets is their difficulty the environmental impact of food, this research in changing behaviors and culturally acquired found seven studies performing this analysis with tastes, but also by other determinants such as lack a broad range of foods. Ten other studies investi- of knowledge, motivation and affordable prices. gated specific foodstuffs, such as organics, com- In this regard, strategies and interventions pared to conventional foods, fish and seafood, (21 articles) are also studied, which verify the ef- beverages, fruits and vegetables, foods of a given fectiveness of training, messages, labels, actions region or culture, insects, and foods of low nutri- in schools and experiments with decreasing por- tional quality. tions of meat and increasing portions of vege- Regarding nutrients, the most recurrent top- tables in restaurants and military institutions, ics of study are related to protein (five studies), for example. Ten of these studies report the ex- due to the need to reduce/avoid the consump- periences of countries such as the United States, tion of animal products, given their high envi- Qatar, United Kingdom, Italy and organizations ronmental impact. Thus, alternatives to replace (Double Pyramid, developed by the Barilla Cen- animal protein by other sources such as insects, ter for Food & Nutrition Foundation) in building plant proteins and cultured protein are studied. population strategies based on nutrition actions, In addition to this nutrient, the study of sustain- guidelines and guides adjusted to the precepts of able diets has been suggesting that the alterna- sustainable diets. 1841 Ciência & Saúde Coletiva, 26(5):1833-1846, 2021

Agriculture dimension – food production regard, a study23 investigates the impact of the change of food production to 100% organic in One of the dimensions which is implicit in England and Wales, trying to identify how much the studies on sustainable diets is agriculture, this would be feasible for internal supply. In ad- given that one of the precepts of this theme is to dition to this, there are concerns inherent in the add nutrition concerns to the existing food pro- purchase of organics and its determinants in in- duction model. Thus, in an attempt to system- stitutional environments such as schools. atize the articles found in this review, we tried to Finally, studies on wastage are worth men- identify studies that focused on the environmen- tioning, for it pervades the entire production tal impact by considering the production aspect chain, from production to disposal by the con- more than the consumption or the actual diets, sumer. Out of the studies relating food wastage to as they were previously explored. sustainable diets, five were identified problema- Thus, we grouped 63 articles which explored tizing the consumers’ behaviors regarding this is- deeply issues related to local, regional, production sue. Other studies seek to identify what is wasted, (conventional/organic), livestock production, the causes, what can be done to avoid it, and the dairy production and other crops (fish farming, role of retailers and processors in this regard. aquaculture, wine-making, heliciculture), land use, genetic selection, animal feed production, Health dimension use of pesticides and fertilizers, animal welfare, transport (food miles), processing, development As seen in topic 3.2, this dimension has been of new products, crop diversification, seasonality, analyzed through the bias of the nutritional ade- self-consumption, rural tourism, insect breeding, quacy of sustainable diets, but it is also linked to wastage, and other related subjects. other aspects such as how obesity, noncommuni- Studies interested in discussing the location cable diseases (diabetes, cardiovascular diseases, or shortening of the supply chain and its rela- cancers, etc.), nutritional deficiencies, and other tionship with economy and food miles (11 arti- public health issues relate to environmental im- cles) stand out. It is worth mentioning that these pacts and economic issues. These studies identify studies introduced the debates on sustainable that the usual diets have caused, at the same time, diets in the late 1980s and were especially im- a threefold problem – impaired public health, portant until 2010, when studies on the environ- impact on the environment and increased public mental impact of livestock farming also became costs to tackle these issues24,25. relevant. The production of meat, especially cat- One of the scientific fields directly involved tle, started to be considered a great challenge to in this discussion is Nutrition. Therefore, pub- be faced. This is due not only to its high green- lications address the role of the nutritionist to house gases emissions, but also to the need for change this scenario by reviewing their everyday large tracts of land to grow vegetables for the practice and academic curricula, adding the sus- animal feed production (based on soybean and tainable food system matter to their praxis. corn), causing deforestation and loss of biodiversity and making it potentially harmful to the Economic dimension environment. Therefore, studies were conducted aiming to reduce this impact by reviewing issues Articles that studied the economic dimen- such as grazing, genetic improvement, alternative sion of sustainable diets sought not only to un- production of protein sources, such as legumes, derstand the cost of sustainable diets and how algae, insect breeding, artificial meat develop- they determine their consumption, but also ment, and others. other factors. It is worth mentioning the impact With regards to dairy, other possibilities were that certain foods have on the environment and also foreseen, such as the production of beverage public health and how much it means in terms from oats. Regarding fish and seafood, concerns of public and private spending with cardiovascu- about the use and contamination of water and lar diseases, for example, or with climate change. the techniques of production and fishing have Based on this concern, some studies address tax- been discussed. Furthermore, water and soil con- ation on foods like sugary drinks and products tamination was also the focus of research related of animal origin and subsidies to more appropri- to the use of pesticides and fertilizers in crops. ate food. These studies use scenario simulations Organic foods are within this scope of pro- and mathematical models to verify the impact of duction, interacting with consumption. In this these actions on the decrease or increase of con- 1842 Triches RM Triches sumption of certain foods and their effects on ects, programs, actions, policies aimed at more health and environment. Other studies investi- sustainable systems and diets. Articles discuss gate how much more consumers would be will- this theme by raising issues such as ethics, moral- ing to pay for products claimed as “sustainable”, ity, politicized consumption, social inclusion and such as meat production with less water. the responsibility of the various actors. Another group of studies focuses on the role of industry, retail and services in the face of glob- Politics and Governance al challenges and how these sectors can influence food production and consumption to encourage This item is linked to all dimensions, for food a more sustainable food system, or how they can policies are intersectoral and the sustainable di- review their actions to set up initiatives that ad- ets theme will be an increasingly important social dress these concerns. agenda in the coming years. Thus, researchers The studies also seek to identify economic have also been dedicated to the analysis of exist- gains or losses in cases of changes in food pat- ing and needed policies to address this challenge terns or food production for patterns considered and the difficulties in bringing environmental, to be more sustainable. In the wake of these con- agricultural, health and economic issues closer to cerns, a study26 that evaluated food consumption each other. coupled with the sustainable development and In this group of studies, there are those which economic growth of 77 countries stands out. propose the development of a set of policy tools This study pointed out how developed and de- to promote sustainable diets, or the use of the veloping countries would be affected given that, sustainable diets approach to evaluate the in- for instance, increased consumption of meat fa- tegration of existing policies. As we previously vors economic growth whereas this consumption touched upon when discussing consumption, should be decreased for the sake of the planet’s policies regarding nutritional recommenda- sustainability. How to overcome these types of tions and dietary guidelines have been worked impasse? out, posing new challenges to nutrition science regarding what is meant by an “adequate” diet Sociocultural dimension given the contemporary context. In addition to these interventions, policies related to taxation Among the discussions related to the socio- and subsidies have also been proposed in the cultural dimension, few articles dealing with literature. Other articles focus on public food specific diets such as the Mediterranean, Nordic, procurement policies, considering the potential Dutch, Chinese, Indian, and others, focus on this role of the state in fostering green or sustainable aspect, as in most cases they emphasize environ- markets. mental and health analyses. However, they all In the studies discussing governance27,28, the have an important component, that is, the cul- central argument is that a sustainable food sys- tural aspect, including its own cuisine, history, tem can only be achieved by shifting the level of culinary, eating habits, their tastes. In this regard, socioeconomic governance from the private-sec- studies have pointed out that a strategy to re- tor control to the state control. They suggest that duce meat consumption would be the inclusion it would require a full range of interventions, in- of insects in diets. This recommendation faces a cluding ‘hard’ measures such as regulations and strong cultural contestation, since insects in cer- fiscal instruments, as well as approaches such as tain cultures can be considered as food, whereas voluntary agreements, awareness-raising, and in the western diets, they are strongly rejected as education. For the authors, greater regulation of food. In addition, the high consumption of meat multinational corporations is needed, along with in countries such as Argentina and Brazil is large- a more important role for publicly supported re- ly due to habits rooted in their cultures, which search and development, agricultural extension, makes the challenge of making changes or mini- and other initiatives. mizing their intake even more problematic. Beyond their cultural matters, studies within Metrics, measures and models this dimension address social issues, such as the to analyse sustainable diets role of society or social actors in the necessary changes. Thus, as local agriculture is support- Finally, we brought together a group of pa- ed by the community as consumers, actors like pers aiming to problematize the methodologies farmers, food industry and state engage in proj- used to analyze sustainable diets. Each of the di- 1843 Ciência & Saúde Coletiva, 26(5):1833-1846, 2021

mensions considered has its own metrics, mea- ses from the University of São Paulo (USP, from sures and models, which already indicates the 2014 to 2017), two dissertations from the Fed- difficulties in bringing together suitable methods eral University of Santa Catarina (UFSC, 2015 to achieve similar objectives. and 2017), and one dissertation from the Federal One of the most widely used methods to eval- University of Rio Grande do Sul (UFRGS, 2017). uate the environmental impact of food and diets Out of the five articles written in total, one was is the life cycle assessment. Studies that approach published in 2012, two in 2013, one in 2017, and it are characterized by literature reviews, or dis- the latest one in 2018. cussions about its accuracy, subjectivity, and its The topics covered are: label analysis (two ar- ability to measure the complexity of the current ticles); agrobiodiversity, diversity (three articles); food system. Some of these concerns arise from analysis of institutional menus and food services the fact that environmental resources and bur- – school feeding (three articles); discussion on dens (water use, land degradation, and eutrophi- the relationship between health, environment cation) are highly context-dependent. Therefore, and food (two articles); rural tourism (one ar- food Life Cycle Assessment (LCA) depends on ticle); ultra-processed food (one article); dietary local data, since data of other countries are not patterns and water footprint (one article); organ- the same as Brazil’s, for instance. Furthermore, ic food prices and distribution channels (one according to Drewnowski et al.19, the LCA data of article). Out of the five papers published inter- the food products from countries like USA and nationally, two were from the USP (2012 and France are extremely limited. However, the same 2016) on meat intake and its impact on the envi- authors mention that other methodologies are ronment and nutritional quality; two were from needed to evaluate the environmental aspect of the Federal University of Santa Maria (UFSM), food processing, packaging, wastage, and waste on the association between obesity, environ- generated. mental impacts, food and health costs (2015 and Another issue raised is the availability of 2018), and the latest one, from the University of information, such as data on food prices at the Campinas in 2018, on consumer perceptions on national level, population’s dietary patterns, ep- healthy/sustainable/unsustainable diets. idemiological information, and socioeconomic As previously seen, the USP has been the determinants of food choice. As a result, Drewn- main institution in these researches, also taking owski’s19 research group noted that existing stud- into account that the elaboration of the current ies on sustainable food and diets produced only Dietary Guideline for the Brazilian Population30,31 partial and fragmented responses. The lack of was, to a large extent, planned by its researchers. empirical data to build and test models is a chal- This Guide is an international benchmark as an lenge. instrument that added to nutritional recommen- On the other hand, researchers have been dations, concerns about the food system, and working on these methodological matters, such sustainability of diets. as the study by Gazan et al29, which proposes to Nevertheless, this scenario shows that the create in France a methodology that will gather country is beginning its academic interest in this analysis metrics for each dimension of sustain- subject, but it still is a long way from having a con- able diets in a single database. Others have been sistent engagement when compared to European using and developing other instruments, such countries. The research agenda on this theme in as remote sensing to capture the use of water in Brazil is to be explored from all aspects that have some crops such as wheat, rice and corn at local, been identified in international research. regional and global levels.

Sustainable diets as a new and challenging Conclusions research agenda in Brazil The discussion on sustainable diets is recent but When searching the bibliographic databases is on the rise. The idea is that our diets should with the uniterms ‘sustainable diet(s)’ in Portu- be set up to have the potential to recalibrate the guese, 14 papers were written in Brazil about or current food system that compromises the abil- tangent to this discussion (besides the five works ity to produce food in the future and can have previously mentioned which were published in irreversible effects on the ecosystem and health. international journals, totaling 19 works). Out It is important to recognize that the myth of the of these 14 works, six were dissertations or the- twentieth century, that humans could eat what 1844 Triches RM Triches and what they wanted without consequences for ing the emission of gases, use of land and water anyone but for themselves, must be overturned of the food that is produced/consumed, which because the planet has its limits. practically precludes more accurate investiga- The analysis of the articles on this topic tions on the environmental impacts of diets in demonstrates a variety of studies that mainly the country. addressed: contributions to the construction of In addition, although there have been in Bra- this concept; analysis of diets and foods and their zil more discussions on food and nutrition secu- relation with the five dimensions of sustainable rity and sustainable development which are ag- diets; understanding of consumer behavior; gregating proposals for sustainability32-33, the role analysis of the environmental impacts of agri- of diets is still marginalized, which requires more culture; analysis of economic and socio-cultural attention and strength as a purpose of broader aspects and their relation with the achievement and more in-depth research and not just tangen- of a sustainable diet; relationship of health with tial, as in most published works. other aspects of diet (environment) and not only Therefore, this research area is open to a wide nutritional; discussion of effective policies and range of fields, such as Nutrition, Agronomy, Vet- forms of governance; search for efficient meth- erinary Medicine, Biology, Ecology, Sociology, ods to carry out these research. Economics, Engineering, and others. Moreover, The state of the art on this theme described we highlight the Nutrition field, where this de- in this article opens many perspectives of studies bate should be added to its range of subjects for in Brazil. For example, about methodology, the teaching, research and extension activities, given life cycle assessments of food are almost non-ex- the challenge of answering the question ‘What is istent, and therefore there is no database includ- an adequate diet in the 21st century?’ 1845 Ciência & Saúde Coletiva, 26(5):1833-1846, 2021

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Article submitted 11/09/2018 Approved 01/08/2019 Final version submitted 03/08/2019

Chief Editors: Romeu Gomes, Antônio Augusto Moura da Silva

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