The possible relationship between diet and mortality remains an important area of investigation. Previous studies have identified dietary factors associated with mortality. Those found to correlate with reduced mortality include nuts,^1-4 fruit,^5,6 cereal fiber,² polyunsaturated fatty acids (PUFAs),² ω-3PUFAs,³ green salad,⁷ Mediterranean dietary patterns,^8-11 “healthy” or “prudent” dietary patterns,^10,12,13 plant-based diet scores,¹⁴ plant-based low-carbohydrate diets,¹⁵ and vegetarian diets.^4,16,17 Associations with increased mortality have been found for a high glycemic load,² meat,^6,7 red meat,^18,19 processed meat,^18,19 eggs,⁷ potatoes,⁵ increased energy intake,²⁰ and animal-based low-carbohydrate diets.¹⁵

Meat consumption is a major contributor to global warming. Given the worldwide growing demand of meat, and the severe impact of meat production on the planet, reducing animal protein consumption is a matter of food security and public health. Changing consumer food behavior is a challenge. Taste preferences, culinary traditions and social norms factor into food choices. Since behavioral change cannot occur without the subject’s positive attitude based on reasons and motivations, a total of 34 papers on consumer attitudes and behavior towards meat consumption in relation to environmental concerns were examined. The results show that consumers aware of the meat impact on the planet, willing to stop or significantly reduce meat consumption for environmental reasons, and who have already changed their meat intake for ecological concerns are a small minority. However, environmental motives are already appealing significant proportions of Westerners to adopt certain meat curtailment strategies. Those who limit meat intake for environmental reasons are typically female, young, simply meat-reducer (not vegan/vegetarian), ecology-oriented, and would more likely live in Europe and Asia than in the U.S.

Bkground.— Although dietary factors are suspected to be important determinants of coronary heart disease (CHD) risk, the direct evidence is relative-lse. Methods.— The Adventist Health Study is a prospective cohort investigation of 31 208 non-Hispanic white California Seventh-Day Adventists. Extensive dietary information was obtained at baseline, along with the values of traditional coronary risk factors. These were related to risk of definite fatal CHD or definite nonfatal- dial infarction. Results.— Subjects who consumed nuts frequently (more than four times per week) experienced substantially fewer definite fatal CHD events (relative risk, 0.52; 95% confidence interval [CI], 0.36 to 0.76) and definite nonfatal myocardial infarctions (relative risk, 0.49; 95% CI, 0.28 to 0.85), when compared with those who consumed nuts less than once per week. These findings persisted on covariate adjustment and were seen in almost all of 16 different subgroups of the population. Subjects who usually consumed whole wheat bread also experienced lower rates of definite nonfatal myocardial infarction (relative risk, 0.56; 95% CI, 0.35 to 0.89) and definite fatal CHD (relative risk, 0.89; 95% CI, 0.60 to 1.33) when compared with those who usually ate white bread. Men who ate beef at least three times each week had a higher risk of definite fatal CHD (relative risk, 2.31; 95% CI, 1.11 to 4.78), but this effect was not seen in women or for the nonfatal myocardial infarction end point. Conclusion.— Our data strongly suggest that the frequent consumption of nuts may protect against risk of CHD events. The favorable fatty acid profile of many nuts is one possible explanation for such an effect. (Arch Intern Med. 1992;152:1416-1424)

Plant-based diets in comparison to diets rich in animal products are more sustainable because they use many fewer natural resources and are less taxing on the environment. Given the global population explosion and increase in wealth, there is an increased demand for foods of animal origin. Environmental data are rapidly accumulating on the unsustainability of current worldwide food consumption practices that are high in meat and dairy products. Natural nonrenewable resources are becoming scarce, and environmental degradation is rapidly increasing. At the current trends of food consumption and environmental changes, food security and food sustainability are on a collision course. Changing course (to avoid the collision) will require extreme downward shifts in meat and dairy consumption by large segments of the world's population. Other approaches such as food waste reduction and precision agriculture and/or other technological advances have to be simultaneously pursued; however, they are insufficient to make the global food system sustainable. For millennia, meatless diets have been advocated on the basis of values, and large segments of the world population have thrived on plant-based diets. "Going back" to plant-based diets worldwide seems to be a reasonable alternative for a sustainable future. Policies in favor of the global adoption of plant-based diets will simultaneously optimize the food supply, health, environmental, and social justice outcomes for the world's population. Implementing such nutrition policy is perhaps one of the most rational and moral paths for a sustainable future of the human race and other living creatures of the biosphere that we share.

Dietary interventions to lower blood cholesterol concentrations and to modify blood lipoprotein levels are the cornerstone of prevention and treatment plans for coronary heart disease (CHD).¹ Recently, consumption of nuts has been the focus of intense research because of their potential to reduce CHD risk and to lower blood lipid levels based on their unique nutritional attributes.^2,3 Nuts are a nutrient-dense food rich in plant protein (10%-25%) and fat (50%-75%), mostly unsaturated fatty acids.^2-4 They are a rich source of additional nutrients, dietary fiber, minerals (eg, copper, magnesium, and potassium), vitamins (eg, folic acid, niacin, vitamin E, and vitamin B₆), and other bioactive constituents such as phenolic antioxidants and phytosterols.^2-4

Epidemiologic and clinical trial evidence has demonstrated consistent benefits of nut and peanut consumption on coronary heart disease (CHD) risk and associated risk factors. The epidemiologic studies have reported various endpoints, including fatal CHD, total CHD death, total CHD, and nonfatal myocardial infarct. A pooled analysis of 4 U.S. epidemiologic studies showed that subjects in the highest intake group for nut consumption had an ∼35% reduced risk of CHD incidence. The reduction in total CHD death was due primarily to a decrease in sudden cardiac death. Clinical studies have evaluated the effects of many different nuts and peanuts on lipids, lipoproteins, and various CHD risk factors, including oxidation, inflammation, and vascular reactivity. Evidence from these studies consistently shows a beneficial effect on these CHD risk factors. The LDL cholesterol-lowering response of nut and peanut studies is greater than expected on the basis of blood cholesterol-lowering equations that are derived from changes in the fatty acid profile of the diet. Thus, in addition to a favorable fatty acid profile, nuts and peanuts contain other bioactive compounds that explain their multiple cardiovascular benefits. Other macronutrients include plant protein and fiber; micronutrients including potassium, calcium, magnesium, and tocopherols; and phytochemicals such as phytosterols, phenolic compounds, resveratrol, and arginine. Nuts and peanuts are food sources that are a composite of numerous cardioprotective nutrients and if routinely incorporated in a healthy diet, population risk of CHD would therefore be expected to decrease markedly.