Promoting both a healthy diet and at the same time considering the environmental sustainability aspects of production and consumption of the diet are urgent global issues. We developed the WISH (World Index for Sustainability and Health) to evaluate diets for healthiness and sustainability. The WISH seeks to measure two complex multidimensional concepts, diet quality and environmental sustainability, in one scoring system. The WISH is based on the EAT-Lancet recommendations for a healthy and sustainable diet in the general population with global applicability across multiple settings. Thirteen food groups are scored between 0 and 10, based on their association with disease and impact on environmental indicators. The scoring system was applied using a dataset of duplicate 24 h dietary recalls from 396 urban Vietnamese men and women. Out of a maximum score of 130, the mean total WISH score was 46 (SD 11), and scores for the healthy and high-environmental impact sub-scores were mean 25 (11) (out of 100) and mean 26 (8) (out of 70) respectively. A higher score was observed for the less-healthy (mean 20 (2) out of 30) sub-score. Our initial analysis shows that the WISH is able to differentiate between the healthiness and the environmental sustainability of a Vietnamese diet.

Food systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.

Our study assessed the effectiveness of a community‐based participatory approach in increasing micronutrient adequacy of diets of women and young children through agricultural activities and nutrition education in Vihiga County, Western Kenya. Outcome indicators include the mean dietary diversity score (DDS), the percentage of women and children reaching minimum dietary diversity (MDD), and micronutrient adequacy (mean adequacy ratio). The project consisted of(a) a diagnostic survey covering agrobiodiversity and nutrition, (b) participatory development of activities to improve nutrition, (c) a baseline survey covering dietary intakes, (d) participatory implementation of the developed activities, and (e) an endline survey covering dietary intakes. The diagnostic survey was conducted in 10 sublocations of Vihiga County, which were pair‐matched and split into five intervention and five control sublocations. The intervention sublocations developed activities towards improving nutrition. Before implementation, a baseline survey collected the dietary intake data of 330 women–child pairs in the intervention and control sublocations. To support the activities, communities received agriculture and nutrition training. After 1 year of implementation, an endline survey collected dietary intake data from 444 women–child pairs in the intervention and control sublocations. Impact was assessed using the difference‐in‐difference technique. Highly significant positive impacts on children's mean DDS (treatment effect = 0.7, p < 0.001) and on the share of children reaching MDD (treatment effect = 0.2, p < 0.001) were shown. Higher dietary diversity can be explained by the development of subsistence and income‐generating pathways and increased nutrition knowledge. Participatory farm diversification and nutrition education were shown to significantly increase dietary diversity of young children in Western Kenya.

Due to complex interactions, changes in any one area of food systems are likely to impact—and possibly depend on—changes in other areas. Here we present the first annual monitoring update of the indicator framework proposed by the Food Systems Countdown Initiative, with new qualitative analysis elucidating interactions across indicators. Since 2000, we find that 20 of 42 indicators with time series have been trending in a desirable direction, indicating modest positive change. Qualitative expert elicitation assessed governance and resilience indicators to be most connected to other indicators across themes, highlighting entry points for action—particularly governance action. Literature review and country case studies add context to the assessed interactions across diets, environment, livelihoods, governance and resilience indicators, helping different actors understand and navigate food systems towards desirable change.

Background: Food biodiversity, encompassing the variety of plants, animals, and other organisms consumed as food and drink, has intrinsic potential to underpin diverse, nutritious diets and improve Earth system resilience. Dietary species richness (DSR), which is recommended as a crosscutting measure of food biodiversity, has been positively associated with the micronutrient adequacy of diets in women and young children in low- and middle-income countries (LMICs). However, the relationships between DSR and major health outcomes have yet to be assessed in any population. Methods and findings: We examined the associations between DSR and subsequent total and cause-specific mortality among 451,390 adults enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) study (1992 to 2014, median follow-up: 17 years), free of cancer, diabetes, heart attack, or stroke at baseline. Usual dietary intakes were assessed at recruitment with country-specific dietary questionnaires (DQs). DSR of an individual’s yearly diet was calculated based on the absolute number of unique biological species in each (composite) food and drink. Associations were assessed by fitting multivariable-adjusted Cox proportional hazards regression models. In the EPIC cohort, 2 crops (common wheat and potato) and 2 animal species (cow and pig) accounted for approximately 45% of self-reported total dietary energy intake [median (P₁₀–P₉₀): 68 (40 to 83) species consumed per year]. Overall, higher DSR was inversely associated with all-cause mortality rate. Hazard ratios (HRs) and 95% confidence intervals (CIs) comparing total mortality in the second, third, fourth, and fifth (highest) quintiles (Qs) of DSR to the first (lowest) Q indicate significant inverse associations, after stratification by sex, age, and study center and adjustment for smoking status, educational level, marital status, physical activity, alcohol intake, and total energy intake, Mediterranean diet score, red and processed meat intake, and fiber intake [HR (95% CI): 0.91 (0.88 to 0.94), 0.80 (0.76 to 0.83), 0.69 (0.66 to 0.72), and 0.63 (0.59 to 0.66), respectively; P_Wald < 0.001 for trend]. Absolute death rates among participants in the highest and lowest fifth of DSR were 65.4 and 69.3 cases/10,000 person-years, respectively. Significant inverse associations were also observed between DSR and deaths due to cancer, heart disease, digestive disease, and respiratory disease. An important study limitation is that our findings were based on an observational cohort using self-reported dietary data obtained through single baseline food frequency questionnaires (FFQs); thus, exposure misclassification and residual confounding cannot be ruled out. Conclusions: In this large Pan-European cohort, higher DSR was inversely associated with total and cause-specific mortality, independent of sociodemographic, lifestyle, and other known dietary risk factors. Our findings support the potential of food (species) biodiversity as a guiding principle of sustainable dietary recommendations and food-based dietary guidelines.

Fruit and vegetable consumption is recommended in numerous food-based dietary guidelines and forms a key recommendation in many international statements related to healthy diets. There are thousands of fruit and vegetable species from which to choose, but despite this abundance from nature, populations in most countries neither produce nor consume the recommended daily amounts of fruits and vegetables. There is enormous potential to better incorporate the wealth of diverse fruit and vegetable species and varieties into food systems. Known and preserved by indigenous communities, these hidden food treasures can foster collaborative research and learning. This perspective from the Task Force on Traditional and Indigenous Food Systems and Nutrition of the International Union of Nutritional Sciences (IUNS) highlights 5 key actions that can be taken by individuals, communities, and nations to reshape dialogue about traditional and indigenous fruits and vegetables to benefit people and planetary ecosystems.