Objective: This study aimed to identify diets with improved nutrient quality and environmental impact within the boundaries of dietary practices. Design: We used Data Envelopment Analysis to benchmark diets for improved adherence to food-based dietary guidelines (FBDG). We then optimised these diets for dietary preferences, nutrient quality and environmental impact. Diets were evaluated using the Nutrient Rich Diet score (NRD15.3), diet-related greenhouse gas emission (GHGE) and a diet similarity index that quantified the proportion of food intake that remained similar as compared with the observed diet. Setting: National dietary surveys of four European countries (Denmark, Czech Republic, Italy and France). Subjects: Approximately 6500 adults, aged 18–64 years. Results: When dietary preferences were prioritised, NRD15·3 was ~6 % higher, GHGE was ~4 % lower and ~85 % of food intake remained similar. This diet had higher amounts of fruit, vegetables and whole grains than the observed diet. When nutrient quality was prioritised, NRD15·3 was ~16 % higher, GHGE was ~3 % lower and ~72 % of food intake remained similar. This diet had higher amounts of legumes and fish and lower amounts of sweetened and alcoholic beverages. Finally, when environmental impact was prioritised, NRD15·3 was ~9 % higher, GHGE was ~21 % lower and ~73 % of food intake remained similar. In this diet, red and processed meat partly shifted to either eggs, poultry, fish or dairy. Conclusions: Benchmark modelling can generate diets with improved adherence to FBDG within the boundaries of dietary practices, but fully maximising health and minimising GHGE cannot be achieved simultaneously.

The overconsumption of meat has been charged with contributing to poor health and environmental degradation. Replacing meat with non-meat protein sources is one strategy advocated to reduce meat intake. This narrative review aims to identify the drivers and inhibitors underlying replacing meat with non-meat protein sources in omnivores and flexitarians in developed countries. A systematic search was conducted in Scopus and Web of Science until April 2021. In total, twenty-three studies were included in this review examining personal, socio-cultural, and external factors. Factors including female gender, information on health and the environment, and lower price may act as drivers to replacing meat with non-meat protein sources. Factors including male gender, meat attachment, food neophobia, and lower situational appropriateness of consuming non-meat protein sources may act as inhibitors. Research is needed to establish the relevance of socioeconomic status, race, ethnicity, religion, health status, food environment, and cooking skills. Future studies should prioritize standardizing the definitions of meat and non-meat protein replacements and examining factors across different consumer segments and types of non-meat protein sources. Thereby, the factors determining the replacement of meat with non-meat protein sources can be better elucidated, thus, facilitating the transition to a healthier and more sustainable diet.

Currently, many a priori indexes are being used to assess maternal adherence to the Mediterranean diet (MD) during pregnancy but each with different components, cut-off points, and scoring systems. This narrative review aimed to identify all observational studies utilizing a priori indexes to assess maternal adherence to the MD during pregnancy. A systematic search was conducted in Pubmed until 1 July 2020. Among the 27 studies included, eight different a priori indexes were identified. Studies included a range of 5 to 13 dietary components in their indexes. Only three dietary components—vegetables, fruits, and fish—were common among all indexes. Dairy and alcohol were the only two components modified for pregnancy. All but one study either excluded alcohol from their index or reversed its scoring to contribute to decreased adherence to the MD. Approximately half of the studies established cut-off points based on the distribution of the study population; the others utilized fixed criteria. This review emphasizes the incongruent definitions of the MD impairing effective comparison among studies relating to maternal or offspring health outcomes. Future research should carefully consider the heterogeneous definitions of the MD in a priori indexes and the relevance of incorporating pregnancy-specific nutritional requirements.

Background and aims: Age-related kidney function decline is accelerated in patients with coronary heart disease (CHD). CHD and chronic kidney disease may share common etiologies. We examined plasma fatty acids (FAs) as novel biomarkers of kidney function decline after myocardial infarction (MI). Methods and results: The analysis included 2329 Dutch posteMI patients aged 60-80y (Alpha Omega Cohort) most receiving state-of-the-art medications. Plasma FAs (% total FAs) in cholesteryl esters were assessed at baseline (2002e2006), and w40 months change in creatininecystatin C based glomerular filtration rate was estimated (eGFR, in ml/min per 1.73 m 2 ). Beta coefficients for annual eGFR change in relation to plasma linoleic acid (LA; 50.1% of total FAs in CE), omega-3 FAs (EPA þ DHA; 1.7%), odd-chain FAs (C15:0 and C17:0; 0.2%), and C14:0 (0.7%) were obtained from linear regression analyses adjusted for age, sex, smoking, and alcohol intake. Mean baseline eGFR AESD was 78.5 AE 18.7, which declined by 4.7 AE 13.1 during follow-up, or 1.4 AE 3.9 per year. The annual decline in eGFR was less in patients with higher plasma LA (adjusted beta: 0.40 for LA >47 vs 47%, 95% CI: 0.01; 0.78; p Z 0.046). Associations of plasma LA with annual eGFR decline were stronger in 437 patients with diabetes (1.21, 0.24; 2.19) and in 402 patients with CKD (eGFR<60; 0.90, À0.09; 1.89). Weaker, non-significant associations with kidney function decline were observed for the other plasma FAs. Conclusion: Higher plasma LA may be a good predictor of less kidney function decline after MI, particularly in patients with diabetes.The Alpha Omega Cohort is registered with clinicaltrials.gov, NCT03192410.

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