Global sustainability (health, environment and monetary costs) of three dietary patterns: results from a Spanish cohort (the SUN project)

Ujué Fresán, Miguel Angel Martínez-González, Joan Sabaté, Maira Bes-Rastrollo, Ujué Fresán, Miguel Angel Martínez-González, Joan Sabaté, Maira Bes-Rastrollo

Abstract

Objective: To evaluate the sustainability of the dietary patterns, according to their effects on health and environment and their affordability.

Design: Prospective, ongoing cohort study of university graduates.

Settings: The Spanish SUN project (Seguimiento Universidad de Navarra, University of Navarra Follow-up), starting from 1999.

Participants: A total of 18 429 participants.

Methods: Information from participants is collected every 2 years by validated questionnaires. We assessed three dietary patterns (the Mediterranean, the Western and the Provegetarian dietary patterns). The rate advancement period (RAP) was used to assess the healthiness of each pattern (considering the composite endpoint of all-cause mortality, cardiovascular disease, breast cancer or type 2 diabetes). We also assessed environmental footprints and monetary costs of each dietary pattern.

Results: After a median follow-up of 10.1 years, we identified 469 incident cases of the composite endpoint. The Mediterranean dietary pattern exhibited the best RAP (3.10 years gained [95% CI 4.35 to 1.85] for the highest vs the lowest quartile), while the Western pattern was the unhealthiest pattern (1.33 years lost when comparing extreme quartiles). In a scale between 4 and 16 of harmful environmental effects (the lower, the more environmentally friendly), the Provegetarian pattern scored best (8.82 [95% CI 8.75 to 8.88] when comparing extreme quartiles), whereas the Western pattern was the most detrimental pattern (10.80 [95% CI 10.72 to 10.87]). Regarding monetary costs, the Western pattern was the most affordable pattern (€5.87/day [95% CI 5.82 to 5.93], for the upper quartile), while the Mediterranean pattern was the most expensive pattern (€7.52/day [95% CI 7.47 to 7.56]). The Mediterranean dietary pattern was the most overall sustainable option, closely followed by the Provegetarian pattern. The least overall sustainable pattern was the Western dietary pattern.

Conclusion: Following plant-based diets, like the Mediterranean or Provegetarian dietary patterns, could be a good option in order to achieve an overall sustainable diet.

Trial registration number: NCT02669602; Results.

Keywords: epidemiology; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Adjusted means and 95% CIs of overall sustainable diet index, rate advancement period, environmental footprints index and monetary cost, according to quartiles of Western, Mediterranean and Provegetarian dietary patterns adherence. Adjusted for age, sex and total energy intake. Red line, cross: adherence to the Western dietary pattern. Blue line, diamond: adherence to the Mediterranean dietary pattern. Green line, square: adherence to the Provegetarian dietary pattern.
Figure 2
Figure 2
Adjusted relative means differences and 95% CIIs of overall sustainable diet index, rate advancement period, environmental footprints index and monetary cost, according to quartiles of Western, Mediterranean and Provegetarian dietary patterns adherence, taking as the reference category the first quartile. Adjusted for age, sex and total energy intake. Red line, cross: adherence to the Western dietary pattern. Blue line, diamond: adherence to the Mediterranean dietary pattern. Green line, square: adherence to the Provegetarian dietary pattern.

References

    1. Tapsell LC, Neale EP, Satija A, et al. . Foods, nutrients, and dietary patterns: interconnections and implications for dietary guidelines. Adv Nutr 2016;7:445–54. 10.3945/an.115.011718
    1. Martínez-González MA, Salas-Salvadó J, Estruch R, et al. . Benefits of the Mediterranean diet: insights from the PREDIMED study. Prog Cardiovasc Dis 2015;58:50–60. 10.1016/j.pcad.2015.04.003
    1. Satija A, Bhupathiraju SN, Rimm EB, et al. . Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med 2016;13:e1002039 10.1371/journal.pmed.1002039
    1. Martínez-González MA, Sánchez-Tainta A, Corella D, et al. . A provegetarian food pattern and reduction in total mortality in the Prevención con Dieta Mediterránea (PREDIMED) study. Am J Clin Nutr 2014;100(Suppl 1):320S–8. 10.3945/ajcn.113.071431
    1. Cordain L, Eaton SB, Sebastian A, et al. . Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr 2005;81:341–54. 10.1093/ajcn.81.2.341
    1. Burlingame B, Dernini S. Sustainable diets and biodiversity: directions and solutions for policy, research and action. Proceedings of the International Scientific Symposium ‘Biodiversity and sustainable diets. United agains Hunger’. Rome, Italy: FAO, 2012.
    1. Gussow JD, Clancy KL. Dietary guidelines for sustainability. J Nutr Educ 1986;18:1–5. 10.1016/S0022-3182(86)80255-2
    1. Carlsson-Kanyama A, González AD. Potential contributions of food consumption patterns to climate change. Am J Clin Nutr 2009;89:1704S–9. 10.3945/ajcn.2009.26736AA
    1. Baroni L, Cenci L, Tettamanti M, et al. . Evaluating the environmental impact of various dietary patterns combined with different food production systems. Eur J Clin Nutr 2007;61:279–86. 10.1038/sj.ejcn.1602522
    1. Reijnders L, Soret S. Quantification of the environmental impact of different dietary protein choices. Am J Clin Nutr 2003;78:664S–8. 10.1093/ajcn/78.3.664S
    1. Pimentel D, Pimentel M. Sustainability of meat-based and plant-based diets and the environment. Am J Clin Nutr 2003;78:660S–3. 10.1093/ajcn/78.3.660S
    1. van Dooren C, Marinussen M, Blonk H, et al. . Exploring dietary guidelines based on ecological and nutritional values: A comparison of six dietary patterns. Food Policy 2014;44:36–46. 10.1016/j.foodpol.2013.11.002
    1. Soret S, Mejia A, Batech M, et al. . Climate change mitigation and health effects of varied dietary patterns in real-life settings throughout North America. Am J Clin Nutr 2014;100:490S–5. 10.3945/ajcn.113.071589
    1. Scarborough P, Appleby PN, Mizdrak A, et al. . Dietary greenhouse gas emissions of meat-eaters, fish-eaters, vegetarians and vegans in the UK. Clim Change 2014;125:179–92. 10.1007/s10584-014-1169-1
    1. Bowman S. A methodology to price food consumed: development of a food price database. Fam Econ Nutr Rev 1997;10:26–33.
    1. Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 2015;73:643–60. 10.1093/nutrit/nuv027
    1. Drewnowski A, Darmon N. Food choices and diet costs: an economic analysis. J Nutr 2005;135:900–4. 10.1093/jn/135.4.900
    1. Kant AK, Graubard BI. Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971-1975 to NHANES 1999-2002. Public Health Nutr 2007;10:158–67. 10.1017/S1368980007246749
    1. Gazan R, Barré T, Perignon M, et al. . A methodology to compile food metrics related to diet sustainability into a single food database: Application to the French case. Food Chem 2018;238:125–33. 10.1016/j.foodchem.2016.11.083
    1. Seconda L, Baudry J, Allès B, et al. . Comparing nutritional, economic, and environmental performances of diets according to their levels of greenhouse gas emissions. Clim Change 2018;148:155–72. 10.1007/s10584-018-2195-1
    1. Seguí-Gómez M, de la Fuente C, Vázquez Z, et al. . Cohort profile: the ‘Seguimiento Universidad de Navarra’ (SUN) study. Int J Epidemiol 2006;35:1417–22. 10.1093/ije/dyl223
    1. Martin-Moreno JM, Boyle P, Gorgojo L, et al. . Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 1993;22:512–9. 10.1093/ije/22.3.512
    1. de la Fuente-Arrillaga C, Ruiz ZV, Bes-Rastrollo M, et al. . Reproducibility of an FFQ validated in Spain. Public Health Nutr 2010;13:1364–72. 10.1017/S1368980009993065
    1. Fernández-Ballart JD, Piñol JL, Zazpe I, et al. . Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. Br J Nutr 2010;103:1808–16. 10.1017/S0007114509993837
    1. Pimenta AM, Toledo E, Rodriguez-Diez MC, et al. . Dietary indexes, food patterns and incidence of metabolic syndrome in a Mediterranean cohort: The SUN project. Clin Nutr 2015;34:508–14. 10.1016/j.clnu.2014.06.002
    1. Trichopoulou A, Costacou T, Bamia C, et al. . Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003;348:2599–608. 10.1056/NEJMoa025039
    1. Lopez CN, Martinez-Gonzalez MA, Sanchez-Villegas A, et al. . Costs of Mediterranean and western dietary patterns in a Spanish cohort and their relationship with prospective weight change. J Epidemiol Community Health 2009;63:920–7. 10.1136/jech.2008.081208
    1. Pett MA, Lackey NR, Sullivan JJ. Making sense of factor analysis: the use of factor analysis for instrument development in health care research. 1st edn Thousand Oaks: Sage Publications, 2003.
    1. Martínez-González MA, López-Fontana C, Varo JJ, et al. . Validation of the Spanish version of the physical activity questionnaire used in the Nurses’ Health Study and the Health Professionals’ Follow-up Study. Public Health Nutr 2005;8:920–7. 10.1079/PHN2005745
    1. Bes-Rastrollo M. Validation of self-reported weight and body mass index of the participants of a cohort of university graduates. Rev. Esp. Obes 2005;3:352–8.
    1. Alonso A, Beunza JJ, Delgado-Rodríguez M, et al. . Validation of self reported diagnosis of hypertension in a cohort of university graduates in Spain. BMC Public Health 2005;5:94 10.1186/1471-2458-5-94
    1. Brenner H, Gefeller O, Greenland S. Risk and rate advancement periods as measures of exposure impact on the occurrence of chronic diseases. Epidemiology 1993;4:229–36. 10.1097/00001648-199305000-00006
    1. Liese AD, Hense HW, Brenner H, et al. . Assessing the impact of classical risk factors on myocardial infarction by rate advancement periods. Am J Epidemiol 2000;152:884–8. 10.1093/aje/152.9.884
    1. Fresán U, Martínez-Gonzalez MA, Sabaté J, et al. . The Mediterranean diet, an environmentally friendly option: evidence from the Seguimiento Universidad de Navarra (SUN) cohort. Public Health Nutr 2018;21:1573–82. 10.1017/S1368980017003986
    1. Gobierno de España, Ministerio de Industria, Turismo y Comercio. Precios medios nacionales ponderados de venta al público de productos de alimentación 2002–2008 (Spanish; Spanish Government, Ministry of Industry, Tourism and Commerce. Average national prices for public sale of food products 2002–2016). (Accessed 10 Dec 2016).
    1. Schwingshackl L, Hoffmann G. diet quality as assessed by the healthy eating index, the alternate healthy eating index, the dietary approaches to stop hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies. J Acad Nutr Diet 2015;115:780–800. 10.1016/j.jand.2014.12.009
    1. Zheng J, Huang T, Yu Y, et al. . Fish consumption and CHD mortality: an updated meta-analysis of seventeen cohort studies. Public Health Nutr 2012;15:725–37. 10.1017/S1368980011002254
    1. Heidemann C, Schulze MB, Franco OH, et al. . Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women. Circulation 2008;118:230–7. 10.1161/CIRCULATIONAHA.108.771881
    1. Tilman D, Clark M. Global diets link environmental sustainability and human health. Nature 2014;515:518–22. 10.1038/nature13959
    1. Cade J, Upmeier H, Calvert C, et al. . Costs of a healthy diet: analysis from the UK Women’s Cohort Study. Public Health Nutr 1999;2:505–12. 10.1017/S1368980099000683
    1. Rao M, Afshin A, Singh G, et al. . Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open 2013;3:e004277 10.1136/bmjopen-2013-004277
    1. Schröder H, Serra-Majem L, Subirana I, et al. . Association of increased monetary cost of dietary intake, diet quality and weight management in Spanish adults. Br J Nutr 2016;115:817–22. 10.1017/S0007114515005048
    1. Schepers J, Annemans L, Simoens S. Hurdles that impede economic evaluations of welfare interventions. Expert Rev Pharmacoecon Outcomes Res 2015;15:635–42. 10.1586/14737167.2015.1045492
    1. Schepers J, Annemans L. The potential health and economic effects of plant-based food patterns in Belgium and the United Kingdom. Nutrition 2018;48:24–32. 10.1016/j.nut.2017.11.028
    1. Intergovernmental Panel on Climate Change. Climate Change 2014: Mitigation of Climate Change. Contribution of working Group III to the Fifth Assessment Report of the Intergovermental Panel on Climate Change. Cambridge, United Kingdom and New York, NY, USA: Cambridge University Press, 2014.
    1. Johnson JA, Runge CF, Senauer B, et al. . Global agriculture and carbon trade-offs. Proc Natl Acad Sci U S A 2014;111:12342–7. 10.1073/pnas.1412835111

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