Opportunities for Consistent and Holistic Metrics to Support Food Systems Transformation: A Summary of a Symposium Presented at Nutrition 2023.

There is an urgent need for global food systems transformation to realize a future where planetary health reaches its full potential. Paramount to this vision is the ability of stakeholders across sectors to understand how foods and dietary patterns impact food systems inclusive of all domains of sustainability-environmental, nutrition/health, economic and social. This article is a synopsis of presentations by 3 food systems experts to share the latest science in a session entitled "How do you measure sustainability? Opportunities for consistent and holistic metrics to support food systems transformation" at the American Society for Nutrition's 2023 annual conference. As summarized here, global population data showing widespread malnutrition underscore the important role of dietary diversity through a balance of plant- and animal-source foods to achieve nutritionally adequate diets and reduce risk of noncommunicable diseases. Yet, recent international audits of countries, companies, and organizations and their sustainability targets largely demonstrate an underrepresentation of robust nutrition/health metrics to support public nutrition and health progress. Addressing limitations in diet-sustainability modeling systems provides a viable opportunity to accurately reflect the important contributions and trade-offs of diets across all domains of sustainability to ultimately support evidence-based decision making in advancing healthy food systems.

Restricted carbohydrate diets below 45% energy are not associated with risk of mortality in the National Health and Nutrition Examination Survey, 1999-2018.

Introduction: Cardiometabolic diseases (CMD) are the leading causes of death for people living in the United States. Dietary strategies, such as restricting carbohydrate intake, are becoming popular strategies for improving health status. However, there is limited and often contradictory evidence on whether restricting carbohydrate intake is related to all-cause, CMD, or cardiovascular disease (CVD) mortality. Methods: The objective of the present study was to evaluate the association between restricted carbohydrate diets (<45%en) and mortality from all-causes, CMD, and CVD, stratified by fat amount and class. Data were acquired using the National Health and Nutrition Examination Survey (1999-2018) linked with mortality follow-up until December 31, 2019 from the Public-use Linked Mortality Files. Multivariable survey-weighted Cox proportional hazards models estimated hazard ratios for 7,958 adults (≥20 y) that consumed <45%en from carbohydrates and 27,930 adults that consumed 45-65%en from carbohydrates. Results: During the study period a total of 3,780 deaths occurred, including 1,048 from CMD and 1,007 from CVD, during a mean follow-up of 10.2 y. Compared to individuals that met carbohydrate recommendations (45-65%en), those that consumed carbohydrate restricted diets (<45%en) did not have significantly altered risk of mortality from all-causes (HR: 0.98; 95% CI: 0.87, 1.11), CMD (1.18; 0.95, 1.46), or CVD (1.20; 0.96, 1.49). These findings were maintained when the restricted carbohydrate diet group was stratified by intake of total fat, saturated fat (SFA), monounsaturated fat (MUFA), and polyunsaturated fat (PUFA). Discussion: Carbohydrate restriction (<45%en) was not associated with mortality from all-causes, CVD, or CMD. Greater efforts are needed to characterize the risk of mortality associated with varied degrees of carbohydrate restriction, e.g., low (<26%en) and high (>65%en) carbohydrate diets separately.

Micronutrient intake from three popular diet patterns in the United States: modeled replacement of foods highest in added sugar and sodium using the National Health and Nutrition Examination Survey, 2005-2018.

Introduction: Fifty-two percent of adults in the United States reported following a popular diet pattern in 2022, yet there is limited information on daily micronutrient intakes associated with these diet patterns. The objective of the present study was to model the impact on micronutrient intake when foods highest in added sugar and sodium were replaced with healthier alternatives to align with the Dietary Guidelines for Americans recommendations. Methods: Dietary data were acquired from 34,411 adults ≥ 20 y in the National Health and Nutrition Examination Survey, 2005-2018. The National Cancer Institute methodology was used to estimate usual dietary intake at baseline of 17 micronutrients using information from up to two dietary recalls per person. A food substitution model was used to evaluate the impact on micronutrient intake when three servings of foods highest in added sugar and sodium were substituted with healthier alternatives. Results: Dietary modeling to replace foods highest in added sugar with healthier alternatives increased the mean intake of fat-soluble vitamins (0.15% for vitamin A to 4.28% for vitamin K), most water-soluble vitamins (0.01% for vitamin B1 to 12.09% for vitamin C), and most minerals (0.01% for sodium to 4.44% for potassium) across all diet patterns. Replacing foods highest in sodium had mixed effects on the mean intake of micronutrients. The intake of most fatsoluble vitamins increased by 1.37-6.53% (particularly vitamin A and D), yet while the intake of some water-soluble vitamins and minerals increased by 0.18-2.64% (particularly vitamin B2, calcium, and iron) others decreased by 0.56-10.38% (notably vitamin B3 and B6, magnesium, sodium, and potassium). Discussion: Modeled replacement of foods highest in added sugar led to more favorable changes in mean micronutrient intake compared to modeled replacement of foods highest in sodium. Due to the composite nature of mixed dishes that include multiple ingredients, food substitutions may result in both favorable and unfavorable changes in micronutrient intake. These findings highlight the challenges of making singleitem food substitutions to increase micronutrient intake and call for further research to evaluate optimal combinations of replacement foods to maximize the intake of all micronutrients simultaneously.

Greater adherence to the Dietary Guidelines for Americans is associated with lower diet-related greenhouse gas emissions but higher costs.

Introduction: Few studies have evaluated the sustainability of popular diet patterns in the US, which limits policy action and impedes consumer efficacy to make sustainable dietary changes. This study filled this gap by evaluating the relationship between diet quality, greenhouse gas emissions (GHGE), and diet cost for plant-based, restricted carbohydrate, low grain, low fat, and time restricted diet patterns. Methods: Dietary data were retrieved from the National Health and Nutrition Examination Survey (2011-2018, n = 8,146) and linked with data on GHGE and food prices from publicly available databases. Diet quality was measured using the Healthy Eating Index-2015. The present study (1) compared the mean diet quality, GHGE, and diet cost between diet patterns, (2) evaluated the association of diet quality to GHGE and diet cost for each diet pattern, and (3) estimated the contribution of food sources to GHGE and diet cost for each diet pattern. Results: Higher diet quality was associated with lower GHGE for the general population and for most diet patterns (p < 0.01) except for the plant-based and time restricted diet patterns (p > 0.05). Higher diet quality was associated with higher cost for the general population and for all dietary patterns (p < 0.01) except the time restricted diet pattern (p > 0.05). Protein foods, mostly beef, accounted for the largest share of GHGE (29-40%) and diet cost (28-47%) for all diet patterns except plant-based. Discussion: Higher diet quality was associated with lower GHGE but was often accompanied by higher diet cost. These sustainability trade-offs can help inform major policy discussions in the US and shed light on further research needs in the area of food systems transformation.

Fat Intake Modifies the Association between Restricted Carbohydrate Diets and Prevalent Cardiometabolic Diseases among Adults in the United States: National Health and Nutrition Examination Survey, 1999-2018.

Background: Cardiometabolic diseases (CMDs), which include heart disease, stroke, and diabetes, account for over one-third of the mortality burden in the United States annually. Nearly one-half of all deaths from CMD are attributable to suboptimal diet quality, and many Americans are turning to special diets for general health improvement. Among the most popular of these diets restrict daily carbohydrate intake to <45% of energy, yet their association with CMD is not well understood. Objectives: This study evaluated the association between restricted carbohydrate diets and prevalent CMD, stratified by fat intake. Methods: Dietary and CMD data were retrieved from 19,078 participants aged ≥20 y in the National Health and Nutrition Examination Survey, 1999-2018. The National Cancer Institute methodology was used to assess usual dietary intake. Results: Compared to participants that met recommendations for all macronutrients, those that consumed restricted carbohydrate diets were 1.15 (95% CI: 1.14, 1.16) times as likely to have CMD; and those that met recommendations for carbohydrates, but not all macronutrients, were 1.02 (95% CI: 1.02, 1.03) times as likely to have CMD. Higher intakes of saturated and polyunsaturated fat were associated with greater prevalence of CMD in restricted and recommended carbohydrate intake groups. Higher intake of monounsaturated fat was associated with lower prevalence of CMD among participants that met carbohydrate, but not all macronutrient, recommendations. Conclusions: To our knowledge, this is the first nationally representative study to evaluate the relationship between carbohydrate restriction and CMD, stratifying by fat intake. Greater efforts are needed to understand longitudinal relationships between carbohydrate restriction and CMD.

Greenhouse gas emissions, cost, and diet quality of specific diet patterns in the United States.

BACKGROUND: Major policy agendas are calling for accelerated investment in research that addresses the impact of diet patterns on multiple domains of sustainability. OBJECTIVES: To evaluate the comparative greenhouse gas emissions, diet cost, and diet quality of plant-based, low-grain, restricted carbohydrate, low-fat, and time-restricted diet patterns on a daily per capita basis. METHODS: Dietary data from the National Health and Nutrition Examination Survey (2013-2016, n = 4025) were merged with data on greenhouse gas emissions (GHGEs) and food prices from multiple databases. The Healthy Eating Index-2015 was used to measure diet quality. RESULTS: The plant-based diet pattern had the lowest GHGEs [3.5 kg carbon dioxide equivalent (CO2eq); 95% confidence interval (CI): 3.3, 3.8 kg CO2eq] and among the lowest diet cost ($11.51; 95% CI: $10.67, $12.41), but diet quality (45.8; 95% CI: 43.3, 48.5) was similar (P > 0.005) to most other diet patterns. All of the sustainability impacts of the low-grain diet pattern were intermediate. The restricted carbohydrate diet pattern had the highest diet cost ($18.46; 95% CI: $17.80, $19.13) but intermediate diet quality (46.8; 95% CI: 45.7, 47.9) and moderate-to-high GHGEs (5.7 kg CO2eq; 95% CI: 5.4, 5.9 kg CO2eq). The low-fat diet pattern had the highest diet quality (52.0; 95% CI: 50.8, 53.1) and intermediate GHGEs (4.4 kg CO2eq; 95% CI: 4.1, 4.6 kg CO2eq) and diet cost ($14.53; 95% CI: $13.73, $15.38). The time-restricted diet pattern had among the lowest diet quality score (42.6; 95% CI: 40.8, 44.6), had GHGEs similar to most other diet patterns (4.6 kg CO2eq; 95% CI: 4.2, 5.0 kg CO2eq), and low-to-moderate diet cost ($12.34; 95% CI: $11.38, $13.40). CONCLUSIONS: Most diet patterns are associated with sustainability trade-offs. The nature of these trade-offs can help inform discussions on food and nutrition policy in the United States, including the National Strategy on Hunger, Nutrition, and Health, and future Dietary Guidelines for Americans.

Carbohydrate Intakes Below Recommendations With a High Intake of Fat Are Associated With Higher Prevalence of Metabolic Syndrome.

BACKGROUND: More than one-third of adults in the United States have metabolic syndrome, and dietary carbohydrate intake may modify the likelihood of developing this condition. Currently, there is a lack of consistent evidence demonstrating the relationship between carbohydrate intake that falls below recommendations and metabolic syndrome. Not accounting for the differences in fatty acid classes of these dietary patterns may be a reason for inconsistent findings. OBJECTIVE: This study evaluated the association between a carbohydrate intake below recommendations and metabolic syndrome stratified by fat quantity and fatty acid classes in a nationally representative sample of US adults. DESIGN: This cross-sectional study acquired data on food and nutrient intake and markers of metabolic syndrome from respondents in the National Health and Nutrition Examination Survey 1999-2018. PARTICIPANTS/SETTING: This study included 19,078 respondents who were aged 20 years or older, had reliable and complete data on food and nutrient intake and markers of metabolic syndrome, and were not pregnant or breastfeeding. MAIN OUTCOME MEASURES: The main outcome was prevalence of metabolic syndrome. STATISTICAL ANALYSES PERFORMED: Usual dietary intake was estimated using the National Cancer Institute's usual intake methodology. Multivariable logistic regression models assessed the relative odds of prevalent metabolic syndrome between those who had a carbohydrate intake below recommendations and those who met carbohydrate recommendations. RESULTS: Those who had a carbohydrate intake below recommendations had 1.067 (95% CI 1.063 to 1.071) times greater odds of having metabolic syndrome compared with those who met carbohydrate recommendations (P < 0.001). High intake of fat of any class was associated with higher odds of metabolic syndrome (total fat: 1.271, 95% CI 1.256 to 1.286; saturated fatty acid: 1.072, 95% CI 1.060 to 1.085; monounsaturated fatty acid: 1.317, 95% CI 1.300 to 1.333; polyunsaturated fatty acid: 1.056, 95% CI 1.047 to 1.066; P < 0.001 for all comparisons) in those who had a carbohydrate intake below recommendations. CONCLUSIONS: The odds of prevalent metabolic syndrome were higher among individuals who had a carbohydrate intake below recommendations compared with individuals who met carbohydrate recommendations.

Consumption of Key Food Groups by Individuals Consuming Popular Diet Patterns: Mixed Effects of Replacing Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains.

Adults in the United States are increasingly following 'popular' diet patterns that restrict food groups, macronutrients, or eating time. However, the intake of food groups associated with these diet patterns has not been well characterized. The objectives of this study were to (1) characterize the mean intake of food groups among consumers of popular diet patterns in the US, and (2) model the effect of targeted food substitutions on the intake of food groups. Data were acquired from the National Health and Nutrition Examination Survey, 2005-2018 (n = 34,411). A diet model was developed to assess the effects of replacing one serving each of foods highest in added sugar, sodium, saturated fat, and refined grains with healthy alternatives on the intake of key food groups for each diet pattern. Modeled replacement resulted in increased intake of fruit and whole grains and decreased intake of dairy for most diet patterns, while the effects on the intake of vegetables, protein foods, and oils were variable across diet patterns. The complexity of the natural eating environment, in which many people consume mixed dishes that include both healthy and less healthy ingredients, produces a challenge for health professionals when providing dietary counseling. Nevertheless, this substitution approach may help improve adherence to dietary guidelines, especially if used as a steppingstone for further dietary improvement.

Quality of Popular Diet Patterns in the United States: Evaluating the Effect of Substitutions for Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains.

Background: Many Americans have adopted popular diet patterns for general health improvement that restrict specific foods, macronutrients, or eating time. However, there is limited evidence to characterize the quality of these diet patterns. Objectives: This study 1) evaluated the quality of popular diet patterns in the United States and 2) modeled the effect of targeted food substitutions on diet quality. Methods: Dietary data from 34,411 adults ≥20 y old were acquired from the NHANES, 2005-2018. Dietary intake was assessed using the National Cancer Institute's usual intake methodology, and the Healthy Eating Index-2015 was used to evaluate diet quality. A diet model was used to evaluate the effect of targeted food substitutions on diet quality. Results: A pescatarian diet pattern had the highest diet quality (65.2; 95% CI: 64.0, 66.4), followed by vegetarian (63.0; 95% CI: 62.0, 64.0), low-grain (62.0; 95% CI: 61.6, 62.4), restricted-carbohydrate (56.9; 95% CI: 56.6, 57.3), time-restricted (55.2; 95% CI: 54.8, 55.5), and high-protein (51.8; 95% CI: 51.0, 62.7) diet patterns. Modeled replacement of ≤3 daily servings of foods highest in added sugar, sodium, saturated fat, and refined grains with alternative foods led to an increase in diet quality and a decrease in energy intake for most diet patterns. Conclusions: Low diet quality was observed for all popular diet patterns evaluated in this study. Modeled dietary shifts that align with recommendations to choose foods lower in added sugar, sodium, saturated fat, and refined grains led to modest improvements in diet quality and larger reductions of energy intake. Greater efforts are needed to encourage the adoption of dietary patterns that emphasize consumption of a variety of high-quality food groups.

Diet Sustainability Analyses Can Be Improved With Updates to the Food Commodity Intake Database.

Diet sustainability analyses inform policymaking decisions and provide clinicians and consumers with evidence-based information to make dietary changes. In the United States, the Food Commodity Intake Database (FCID) provides a crosswalk for integrating nationally representative data on food intake from the National Health and Nutrition Examination Survey (NHANES) with data on sustainability outcomes from other publicly available databases. However, FCID has not been updated since 2010 and does not link with contemporary NHANES data, which limits further advancements in sustainability research. This study fills this research gap by establishing novel linkages between FCID and NHANES 2011-2018, comparing daily per capita food intake with and without these linkages, and making these data publicly available for use by other researchers. To update FCID, two investigators independently established novel data linkages, a third investigator resolved discrepancies, and a fourth investigator audited linkages for accuracy. Dietary data were acquired from nearly 45,000 adults from 2001 to 2018, and food intake was compared between updated vs. non-updated FCID versions. Total food intake from 2011 to 2018 was 5-23% higher using the updated FCID compared to the non-updated version, and intake was over 100% higher in some years for some food categories including poultry, eggs, legumes, starchy vegetables, and tropical oils (P < 0.001 for all comparisons). Further efforts may be needed to create new food composition data to reflect new products and reformulations that enter the food supply over time. This study removes a barrier to further diet sustainability analyses by establishing a data crosswalk between contemporary NHANES and other publicly available databases on agricultural resource use, environmental impacts, and consumer food expenditures.

Affordability influences nutritional quality of seafood consumption among income and race/ethnicity groups in the United States.

BACKGROUND: The 2020 US Dietary Guidelines for Americans recommend that the US population consume more seafood. Most analyses of seafood consumption ignore heterogeneity in consumption patterns by species, nutritional content, production methods, and price, which have implications for applying recommendations. OBJECTIVES: We assessed seafood intake among adults by socioeconomic and demographic groups, as well as the cost of seafood at retail to identify affordable and nutritious options. METHODS: NHANES 2011-2018 dietary data (n = 17,559 total, n = 3285 eating seafood) were used to assess adult (≥20 y) intake of seafood in relation to income and race/ethnicity. Multivariable linear regression assessed the association between seafood consumption and income, adjusted for age, sex, and race/ethnicity, and the association between nutrients and seafood price, using Nielsen 2017-2019 retail sales data, adjusted for sales volume. RESULTS: Low-income groups consume slightly less seafood than high-income groups [low income: mean 120.2 (95% CI: 103.5, 137.2) g/wk; high income: 141.8 (119.1, 164.1) g/wk] but substantially less seafood that is high in long-chain n-3 (ω-3) PUFAs [lower income: 21.3 (17.3, 25.5) g/wk; higher income: 46.8 (35.4, 57.8) g/wk]. Intake rates, species, and production method choices varied by race/ethnicity groups and within race/ethnicity groups by income. Retail seafood as a whole costs more than other protein foods (e.g., meat, poultry, eggs, beans), and fresh seafood high in n-3 PUFAs costs more (P < 0.002) than fresh seafood low in n-3 PUFAs. Retail seafood is available in a wide range of price points and product forms, and some lower-cost fish and shellfish were high in n-3 PUFAs, calcium, iron, selenium, and vitamins B-12 and D. CONCLUSIONS: New insights into the relation between seafood affordability and consumption patterns among income and ethnicity groups suggest that specific policies and interventions may be needed to enhance the consumption of seafood by different groups.

Modeled Substitution of Traditional Oils with High-Oleic Acid Oils Decreases Essential Fatty Acid Intake in Children.

BACKGROUND: High-oleic acid (OA) vegetable oils are replacing some traditional vegetable oils in the US food supply. This may lead to reduced intake of the essential fatty acids (EFAs) linoleic acid (18:2n-6) and α-linolenic acid (18:3n-3) in children, who need EFAs for growth and development and reduced risk for cardiometabolic disease into adulthood. OBJECTIVES: The objectives of this study were the following: 1) to estimate trends in daily intake of EFAs among children aged 1-8 y, 2) identify top food sources of EFAs, and 3) evaluate the effects of replacing traditional oils with high-OA oils on meeting daily recommended intakes of EFAs. METHODS: Dietary data from 7814 children aged 1-8 y were acquired from the NHANES (2007-2016). Using a diet model, we evaluated the effect of replacing 20%, 40%, 60%, and 80% of traditional oils with high-OA oils on meeting adequate intakes (AIs) for EFAs. RESULTS: Major food sources of EFAs among all age-sex groups were grain dishes (35-40% of daily intake), meat and seafood dishes (17-21%), and fruit and vegetable dishes (12-14%). Replacing 40% or more of traditional oils with high-OA oil varieties will lead to inadequate daily intakes of EFAs. CONCLUSION: Replacement of traditional vegetable oils with high-OA varieties will place children at risk of not meeting the AI levels for EFAs. A balanced approach of including traditional oils and high-OA oils in the US food supply is needed to prevent inadequate intakes of EFAs in children.

Higher-diet quality is associated with higher diet costs when eating at home and away from home: National Health and Nutrition Examination Survey, 2005-2016.

OBJECTIVES: To evaluate the association between diet quality and cost for foods purchased for consumption at home and away from home. DESIGN: Cross-sectional analysis. Multivariable linear regression models evaluated the association between diet quality and cost for all food, food at home (FAH) and food away from home (FAFH). SETTING: Daily food intake data from the National Health and Nutrition Examination Survey (2005-2016). Food prices were derived using data from multiple, publicly available databases. Diet quality was assessed using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010. PARTICIPANTS: 30 564 individuals ≥20 years with complete and reliable dietary data. RESULTS: Mean per capita daily diet cost was $14·19 (95 % CI (13·91, 14·48)), including $6·92 (95 % CI (6·73, 7·10)) for FAH and $7·28 (95 % CI (7·05, 7·50)) for FAFH. Diet quality was higher for FAH compared to FAFH (P < 0·001). Higher diet quality was associated with higher food costs overall, FAH and FAFH (P < 0·001 for all comparisons). CONCLUSIONS: These findings demonstrate that higher diet quality is associated with higher costs for all food, FAH and FAFH. This research provides policymakers, public health professionals and clinicians with information needed to support healthy eating habits. These findings are particularly relevant to contemporary health and economic concerns that have worsened because of the COVID-19 pandemic.

Evaluating Moderation of Parent-Teen Overweight/Obesity Relation by Household Socioeconomic Status.

Evidence links parent-offspring weight status, but few studies have evaluated whether markers of socioeconomic status moderate this relation. The 2014 Family Life, Activity, Sun, Health, and Eating study was used to assess intergenerational weight status in a national sample of parent-teen dyads. Multivariable logistic regression models assessed the relation between parent-teen weight status, controlling for teen and parent dietary factors, physical activity, demographic factors, and socioeconomic factors. Models with interaction assessed moderation by household food security status and participation in federal assistance programs. In fully adjusted models, sons were 2.66 (95% CI: 1.56, 4.55) times more likely to have overweight/obesity if their mother had overweight/obesity, and daughters were 3.35 (95% CI: 1.91, 5.86) times more likely. This relation was stronger in mother-son pairs in households with lower food security. These findings provide important new information that can be used to inform nutritional counseling efforts and educational programs that support families with socioeconomic disadvantage.

Identifying the links between consumer food waste, nutrition, and environmental sustainability: a narrative review.

Emerging research demonstrates unexpected relationships between food waste, nutrition, and environmental sustainability that should be considered when developing waste reduction strategies. In this narrative review, we synthesize these linkages and the evidence related to drivers of food waste and reduction strategies at the consumer level in the United States. Higher diet quality is associated with greater food waste, which results in significant quantities of wasted resources (e.g., energy, fertilizer) and greenhouse gas emissions. Food waste also represents waste of micronutrients that could otherwise theoretically fill nutritional gaps for millions of people. To make progress on these multiple fronts simultaneously, nutrition professionals must expand beyond their traditional purview, into more interdisciplinary arenas that make connections with food waste and environmental sustainability.

Healthy diets can create environmental trade-offs, depending on how diet quality is measured.

BACKGROUND: There is an urgent need to assess the linkages between diet patterns and environmental sustainability in order to meet global targets for reducing premature mortality and improving sustainable management of natural resources. This study fills an important research gap by evaluating the relationship between incremental differences in diet quality and multiple environmental burdens, while also accounting for the separate contributions of retail losses, inedible portions, and consumer waste. METHODS: Cross sectional, nationally-representative data on food intake in the United States were acquired from the National Health and Nutrition Examination Survey (2005-2016), and were linked with nationally-representative data on food loss and waste from published literature. Survey-weighted procedures estimated daily per capita food retail loss, food waste, inedible portions, and consumed food, and were summed to represent Total Food Demand. Diet quality was measured using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010. Data on food intake, loss, and waste were inputted into the US Foodprint Model to estimate the amount of agricultural land, fertilizer nutrients, pesticides, and irrigation water used to produce food. RESULTS: This study included dietary data from 50,014 individuals aged ≥2 y. Higher diet quality (HEI-2015 and AHEI-2010) was associated with greater per capita Total Food Demand, as well as greater retail loss, inedible portions, consumer waste, and consumed food (P < 0.001 for all comparisons). Consumed food accounted for 56-74% of agricultural resource use (land, fertilizer nutrients, pesticides, and irrigation water), retail loss accounted for 4-6%, inedible portions accounted for 2-15%, and consumer waste accounted for 20-23%. Higher diet quality was associated with lower use of agricultural land, but the relationship to other agricultural resources was dependent on the tool used to measure diet quality (HEI-2015 vs. AHEI-2010). CONCLUSIONS: Over one-quarter of the agricultural inputs used to produce Total Food Demand were attributable to edible food that was not consumed. Importantly, this study also demonstrates that the relationship between diet quality and environmental sustainability depends on how diet quality is measured. These findings have implications for the development of sustainable dietary guidelines, which requires balancing population-level nutritional needs with the environmental impacts of food choices.

Impact of beef consumption on saturated fat intake in the United States adult population: Insights from modeling the influences of bovine genetics and nutrition.

We sought to determine the impact of breed and finishing ration that reduces the saturated fat (SFA) content of beef on SFA intake (%E) in adults. Using National Health and Nutrition Examination Surveys (2001-2016), we replaced the current fatty acid profile of beef with that from two breeds (Angus, Wagyu) and three finishing rations (pasture, 15% flaxseed supplementation, 35% wet distiller's grain (WDG) supplementation). Dietary replacement levels in the model were 10%, 25%, 50%, 100%. Overall, men consumed more beef fat than women (12.0 g (11.6-12.4 g, 95%CI) and 6.6 g (6.4-6.9 g, 95%CI), respectively). The contribution of beef fat to SFA intake was 2.1%E (2.1-2.2%E, 95%CI) in men and 1.6%E (1.6-1.7%E, 95%CI) in women. SFA intake decreased with each increased replacement level for all beef types. At 100% replacement, SFA intake decreased 0.5% (Angus), 2.8% (Wagyu), 1.9% (pasture), 4.1% (flaxseed), 2.6% (WDG). Our findings demonstrate that breed and finishing ration that reduces the SFA content of beef can decrease population-level SFA intake.

Food Sources and Expenditures for Seafood in the United States.

The aim of this study was to explore United States (U.S.) seafood consumption patterns, food sourcing, expenditures, and geography of consumption. We analyzed seafood intake and food sourcing using the National Health and Nutrition Examination Survey (NHANES) cycles 2007-2008 to 2015-2016 for US adults ≥19 years old (n = 26,743 total respondents; n = 4957 respondents consumed seafood in the past 24 h). Seafood expenditures were extrapolated by combining NHANES with three other public datasets. U.S. adults consumed 63% of seafood (by weight) at home. The top sources of seafood (by weight) were food retail (56%), restaurants (31%), and caught by the respondent or someone they know (5%). Sixty-five percent of consumer expenditures for seafood were at restaurants and other "away from home" sources while 35% were at retail and other "at home" sources. Slightly less than half of overall U.S. food expenditures are "away from home," which is much lower than for seafood, suggesting that consumers have very different spending habits for seafood than for an aggregate of all foods.

Daily cost of consumer food wasted, inedible, and consumed in the United States, 2001-2016.

BACKGROUND: Consumer food waste in the United States represents substantial amounts of wasted nutrients, as well as needless environmental impact from wasted agricultural inputs, energy use, and greenhouse gas emissions. Efforts to reduce food waste at the consumer level are urgently needed to address the most prominent nutrition and environmental sustainability issues we now face. Importantly, individuals report that saving money is a salient motivator for reducing food waste, yet contemporary evidence on the consumer cost of wasted food is lacking. The objectives of this study are to 1) estimate the daily per capita cost of food wasted, inedible, and consumed 2) at home and away from home, and 3) by food group. METHODS: This study utilizes cross-sectional, nationally-representative data on food intake from the National Health and Nutrition Examination Survey (2001-2016), linked with nationally representative data on food waste from published literature, as well as data on food prices and food price inflation from multiple publicly-available sources. Survey-weighted procedures estimated daily per capita expenditure on food waste for 39,758 adults aged ≥20 y. RESULTS: Total daily per capita food expenditure was $13.27, representing 27% wasted, 14% inedible, and 59% consumed. The greatest daily food waste expenditures were observed for meat and seafood purchased for consumption outside of the home ($0.94, 95% CI: $0.90-0.99), and fruits and vegetables purchased for consumption in the home ($0.68, $0.63-0.73). CONCLUSIONS: The most cost-effective ways to reduce food waste at the consumer level are to focus waste reduction efforts on meat and seafood purchased for consumption outside of the home and fruits and vegetables purchased for consumption in the home. A number of strategies are available to help consumers reduce their food waste, which can increase their financial flexibility to purchase more healthy foods while simultaneously reducing environmental impact.

Comparing the Recommended Eating Patterns of the EAT-Lancet Commission and Dietary Guidelines for Americans: Implications for Sustainable Nutrition.

The purpose of this research was to compare the global reference diet from the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems (EAT-Lancet) with the healthy eating patterns from the 2015-2020 Dietary Guidelines for Americans (DGA). Conversion factors were developed to quantitatively compare the patterns. These factors are provided to enable investigators to incorporate the EAT-Lancet diet into analyses while maintaining relevance to US-based dietary guidance. Our findings show several areas of agreement between EAT-Lancet and the DGA but key differences in the amounts of whole grains, fruit, starchy vegetables, red meat, nuts and seeds, and discretionary calories. Many of the differences between the patterns reflect divergent approaches to developing dietary recommendations, not only methodologically but also regarding whether current food consumption patterns are considered as constraints on recommendations. Continued interdisciplinary collaboration is needed to advance dietary guidance that promotes sustainable nutrition.