Context: Shifting from current dietary patterns to diets rich in plant-based (PB) foods and lower in animal-based foods (ABFs) is generally regarded as a suitable strategy to improve nutritional health and reduce environmental impacts. Despite the recent growth in supply of and demand for novel plant-based foods (NPBFs), a comprehensive overview is lacking. Objectives: This review provides a synthesis of available evidence, highlights challenges, and informs public health and environmental strategies for purposeful political decision-making by systematically searching, analyzing, and summarizing the available literature. Data Sources: Five peer-reviewed databases and grey literature sources were rigorously searched for publications. Data Extraction: Study characteristics meeting the inclusion criteria regarding NPBF nutrient composition and health and environmental outcomes in high-income countries were extracted. Data analysis: Fifty-seven peer-reviewed and 36 grey literature sources were identified; these were published in 2016–2022. NPBFs typically have substantially lower environmental impacts than ABFs, but the nutritional contents are complex and vary considerably across brands, product type, and main primary ingredient. In the limited evidence on the health impacts, shifts from ABFs to PB meats were associated with positive health outcomes. However, results were mixed for PB drinks, with links to micronutrient deficiencies. Conclusion: If carefully selected, certain NPBFs have the potential to be healthier and nutrient-rich alternatives to ABFs and typically have smaller environmental footprints. More disaggregated categorization of various types of NPBFs would be a helpful step in guiding consumers and key stakeholders to make informed decisions. To enable informed policymaking on the inclusion of NPBFs in dietary transitions as part of a wider net-zero and health strategy, future priorities should include nutritional food standards, labelling, and subdivisions or categorizations of NPBFs, as well as short- and long-term health studies evaluating dietary shifts from ABFs to NPBFs and standardized environmental impact assessments, ideally from independent funders.

The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction (p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01–1.03, I² = 61%) for total fish, 1.04 (1.01–1.07, I² = 46%) for fatty fish, and 1.02 (1.00–1.04, I² = 33%) for lean fish. In men, all associations were null. In women, we observed variation by geographical location: IRRs for total fish were 1.03 (1.02–1.04, I² = 0%) in the Americas and null in other regions. In conclusion, we found evidence of a neutral association between total fish intake and type 2 diabetes in men, but there was a modest positive association among women with heterogeneity across studies, which was partly explained by geographical location and types of fish intake. Future research should investigate the role of cooking methods, accompanying foods and environmental pollutants, but meanwhile, existing dietary regional, national, or international guidelines should continue to guide fish consumption within overall healthy dietary patterns.

Non-Technical Summary To meet the UK's greenhouse gas (GHG) emissions targets, the Climate Change Committee (CCC) recommended to reduce current meat and dairy intake by 20% by 2030. In this study, we modelled the impact of potential dietary changes on GHG emissions and water use with the selected scenarios based on the trend of food purchase and meat and dairy reduction policy. We show that implementing fiscal measures and facilitating innovations in production of meat alternatives would accelerate existing positive trends, help the UK reach the CCC 2030 target of 20% meat and dairy reduction and increase fruit and vegetable intake. Technical Summary We used 2001–2019 data from the Family Food module of the Living Costs and Food Survey (LCF), an annual UK survey of about 5,000 representative households recording quantities of all food and drink purchases, to model four 2030 dietary scenarios: Business as usual (BAU); two fiscal policy scenarios (‘fiscal 10%’ and ‘fiscal 20%’), combining either a 10% meat and dairy tax and a 10% fruit and vegetable subsidy, or a 20% tax and 20% subsidy on the same foods; and an ‘innovation scenario’ substituting traditionally-produced meat and dairy with plant-based analogues and animal proteins produced in laboratories. Compared to 2019 levels, we forecasted reductions in the range of 5–30% for meat and 8–32% for dairy across scenarios. Meat reductions could be up to 21.5% (fiscal20%) and 30.4% (innovation). For all scenarios we forecasted an increase in fruit and vegetables intake in the range of 3–13.5%; with the fiscal 20% scenario showing highest increases (13.5%). GHG emissions and water use reductions were highest for the innovation scenario (−19.8%, −16.2%) followed by fiscal 20% (−15.8%, −9.2%) fiscal 10% (−12.1%, 5.9%) and BAU (−8.3%, −2.6%) scenarios. Compared to average households, low-income households had similar patterns of change, but both past and predicted purchase of meat, fruit and vegetables and environmental footprints were lower. Social Media Summary Meat and dairy-reduction policies would help meet net zero targets and improve population health in the UK.