Sus ainable and Heal hy Die s Supplemen
Te i o ial and Sus ainable
Heal hy Die s
Fa ima Hachem, PhD
1
, Da y Vanham, PhD
2
and Luis A. Mo eno, PhD
3,4
Abs ac
The apid changes ha socie ies ha e gone h ough in he las ew decades ha e led o he inc ease in he
p e alence o malnu i ion in all i s o ms and o he deg ada ion o na u al esou ces and he en i on-
men . The change in he die a y habi s and p oduc ion sys ems a e esponsible o much o his change.
Some e i o ial die s ha e been shown as po en ially capable o e e sing hese ends by posi i ely
con ibu ing o he heal h o people and he en i onmen such as he Medi e anean Die and he New
No dic Die . In his pape , we e iew he con ibu ion o hese 2 die s o heal h and nu i ion and o
en i onmen al, sociocul u al, and economic sus ainabili y p oposing pe inen indica o s. Lea ning om a
cul u ally es ablished die and a cons uc ed one, adeo could be eached o ensu e be e heal h and
sus ainabili y ou comes. S ong ac o s o achie ing his goal lie in building on he sociocul u al app o-
p ia ion o die s, ha ing he p ope ools and indica o s, in es ing in c oss-sec o collabo a ion and policy
cohe ence, and ha ing he necessa y poli ical suppo o push he agenda o sus ainabili y o wa d.
Keywo ds
Medi e anean die , New No dic die , sus ainable heal hy die s, en i onmen ally sus ainable die s,
e i o ial die s
In oduc ion
One o he majo challenges o ou imes is mal-
nu i ion in all i s o ms (unde nu i ion, mic o-
nu ien s de iciencies, and o e weigh and
obesi y). The la es a ailable numbe s o he mal-
nou ished show he ex en o his challenge: 821
million people ha e hunge , 2 billion people ha e
mic onu ien de iciencies; and o e 2 billion pe -
sons a e o e weigh o obese.
1
While he unde -
lying causes o malnu i ion a e complex and
mul i ace ed, die s emain one o i s majo di ec
causes. Recen esea ch also shows ha unheal hy
die s op he lis o he main isk ac o s o he
global bu den o disease.
2
On he o he hand, wha we ea in luences o a
la ge ex en wha and how we p oduce, p ocu e,
dis ibu e, and dispose o ood and impac s he
na u al esou ces used along such p ocesses. A
he global le el, ood p oduc ion accoun s o he
use o 48%and 70%o land and esh wa e
esou ces, espec i ely.
3
Resea ch also shows
ha di e en ypes o die s con ibu e o g een-
house gas emissions di e en ly.
4
1
Food and Ag icul u e O ganiza ion o he Uni ed Na ions,
Rome, I aly
2
Eu opean Commission, Join Resea ch Cen e (JRC), Isp a,
I aly
3
Uni e sidad de Za agoza, Za agoza, Spain
4
Cen o de In es igaci´
on Biom´
edica en Red de Fisiopa olog´
ıa
de la Obesidad y Nu ici´
on (CIBERObn), Ins i u o de Salud
Ca los III, Mad id, Spain
Co esponding Au ho :
Fa ima Hachem, Nu i ion and Food Sys ems Di ision (ESN),
Food and Ag icul u e O ganiza ion o he Uni ed Na ions
(FAO), Viale delle Te me di Ca acalla, Rome 00153, I aly.
Email: [email p o ec ed]
Food and Nu i ion Bulle in
2020, Vol. 41(2S) S87-S103
ªFAO 2020
A icle euse guidelines:
sagepub.com/jou nals-pe missions
DOI: 10.1177/0379572120976253
jou nals.sagepub.com/home/ nb
Facing such challenges, heal hy die s ha can
play a ole in add essing bo h malnu i ion and
en i onmen al conce ns while being ancho ed in
economic and sociocul u al con ex s ha p i i-
lege hei up ake by he conce ned popula ions,
a e o g ea ele ance o global and na ional agen-
das ela ed o sus ainabili y.
The Second In e na ional Con e ence on Nu i-
ion
5
showed ha ood sys ems a e esponsible o
no deli e ing heal hy die s and a global call o
hei ans o ma ion was launched. In his pape ,
we a gue ha some e i o ial die s (some imes
called egional) can be a ca alys in his ans o ma-
i e p ocess by playing an ac i e ole in shi ing
consump ion and p oduc ion in a way ha s ikes
a balance be ween heal h and nu i ion and he di -
e en dimensions o sus ainabili y, ha is, en i on-
men al, economic, and cul u al. Two such die s, he
Medi e anean Die (MD) and he New No dic Die
(NND), a e becoming inc easingly in e es ing o
his ca aly ic ole, especially wi hin he con ex o
Sus ainable De elopmen Goals (SDGs).
The Medi e anean Die
The MD is a e i o ial die ha has i s oo s
en enched in he his o y o he Medi e anean Sea
and i s egion ha was o cen u ies a mee ing poin
and mel ing po o di e en cul u es and ci iliza-
ion; each con e ing some o i s speci ici ies o he
e ol ing die o he egion. I became known as a
heal hy die in he ea ly 1960s as a esul o he wo k
o Ancel Keys who showed he p o ec i e e ec s o
he die s ea en in Sou he n Eu ope agains co ona y
hea disease.
6
The adi ional MD was de ined
o iginally as a die wi h high consump ion o whole
ce eals, legumes, ege ables, ui s, nu s and oli e
oil, a low o mild consump ion o dai y p oduc s,
and a low consump ion o mea and poul y.
7
In 2010, UNESCO added he MD o i s lis o
in angible cul u al he i age o humani y, no only
because o i s nu i ional a ibu es bu also because
o i being a way o li e ha encompasses “a se o
skills, knowledge, p ac ices and adi ions om land-
scape o able, including c ops, ha es ing, ishing,
conse a ion, p ocessing, p epa a ion and, in pa ic-
ula , ood consump ion.”
8
These addi ional dimen-
sions ha e a alue o hei own and a e also p o ing o
be impo an o heal h and nu i ion ou comes.
Today, esea ch poin s o how commensali y sup-
po s heal hy ood habi s and educes he isk o o e -
weigh and obesi y, especially among child en.
9,10
Despi e i s cons ancy o e ime and space, he
MD was shaped by he speci ici ies o i s local con-
ex s and mani es ed i sel in di e en local e -
sions e lec ing he di e si y o local ood sys ems
and cul u al con ex s ac oss coun ies while p ese -
ing he main cha ac e is ics o he adi ional MD.
New No dic Die
The NND is a new cons uc ed die buil wi h
s ong ancho age on o he No dic ood adi ions
o posi i ely con ibu ing o bo h heal h and he
en i onmen . I was launched in 2004 by a g oup
o epu able che s om he No dic egion who
emba ked on edisco e ing local p oduce.
11
I is
cha ac e ized by a high con en o local ui s and
ege ables (especially be ies, cabbages, oo
ege ables, and legumes), esh he bs, po a oes,
plan s and mush ooms, whole g ains, nu s
(na i e), ish and shell ish, seaweed, ee- ange
li es ock (including pigs and poul y), and
game.
12
I comp ises oods adi ionally sou ced
in he No dic coun ies and ocuses on hose om
he wild coun yside and om he sea and lakes.
The NND knew a as -paced di usion in he
No dic egion possibly because i was concei ed
as an iden i y mo emen . Howe e , he suppo i
ecei ed om he No dic Council o Mins e s
13
because i was seen as an oppo uni y o No dic
coope a ion and as a new sou ce o sha ed No dic
iden i y
11
con ibu ed o i s wide-sp ead up ake
by he public. The No dic ood cul u e was pu -
pose ully p omo ed in na ional and global e en s
by he No dic diplomacy and policy make s.
Local na ional e sions o he NND eme ged and
we e used in na ional media and poli ical dis-
cou se. The alo iza ion o he na ional ood a-
di ions in each o he No dic coun ies helped in
he cul u al app op ia ion and in inc easing he
numbe o adap s o a label wi hou a p e ious
his o y in he culina y domain. The inco po a ion
o conce ns o en i onmen al sus ainabili y and
plane a y heal h in he NND has also con ibu ed
o he up ake o his new die as a way o li e.
S88 Food and Nu i ion Bulle in 41(2S)
Heal h Bene i s o Selec ed
Te i o ial Die s
The Medi e anean Die
The li e a u e on he ela ionship be ween he MD
and posi i e heal h ou comes is abundan . Adhe -
ence o he MD has been associa ed wi h a sig-
ni ican educ ion in o al mo ali y, mo ali y
o m ca dio ascula disease (CVD) and cance ,
and wi h cance - isk lowe ing po en ial.
7,14-16
A ecen e iew
6
has con i med he a o able
in luences o he MD on he isk o me abolic
synd ome, obesi y, ype 2 diabe es melli us, can-
ce , and neu odegene a i e diseases.
In 2017, a me a-analysis o obse a ional s ud-
ies in ela ion o CVD showed a 27%lowe isk o
CVD incidence when compa ing high o low MD
adhe ence ca ego ies; he esul s showed ha he
MD educed he isk o CVD incidence by 45%.
17
On he o he hand, o CVD mo ali y, a 25%
lowe isk was ound when compa ing high e -
sus low adhe ence o he MD pa e n as well as
41%dec eased isk o CVD mo ali y.
The MD is belie ed o ha e a o able e ec in
educing blood p essu e in hype ensi e o
heal hy indi iduals; howe e , he e is no enough
in o ma ion o es ima e he s eng h o he
obse ed e ec , and he e o e, mo e s udies a e
necessa y in his ega d.
18
E idence howe e exis s ha people who
adhe e o he MD ha e lowe incidence o cance .
Excep o panc ea ic cance , all o he cance s o
he diges i e ac showed signi ican ly educed
incidence wi h he MD.
19
A ecen sys ema ic e iew on he e ec o MD
in ela ion o cogni i e unc ion
20
showed inconsis-
en esul s o cogni i e unc ion and b ain mo -
phology o connec i i y. Howe e , a signi ican
and clinically ele an e ec sizes we e ound o
cogni i e composi es in he P e enci´on con Die a
Medi e ´anea (PREDIMED) s udy.
21
Fou s udies assessing he associa ion be ween
MD and he isk o ail y we e iden i ied in a
sys ema ic e iew. Highe adhe ence o an MD
was associa ed wi h signi ican ly lowe inciden
ail y isk han lowe adhe ence.
22
Nonalcoholic a y li e disease (NAFLD),
23
which has in lamma ion and oxida i e s ess as
majo isk ac o s, has been s udied in ela ion o
MD. Wi h he MD being low in sa u a ed a s,
animal p o ein, high in an ioxidan s and ibe s,
and ha ing an adequa e omega-3 o omega-6 a y
acids balance, i has been sugges ed o be e ec-
i e in NAFLD. Al hough he esul s om he
a ailable s udies a e encou aging, he e is s ill
need o ials wi h la ge sample size.
24
A sys ema ic e iew on he managemen and
p e en ion o heuma oid a h i is in human p o-
spec i e s udies epo ed imp o emen in he pain
isual analogue scale and a dec ease in he sco e
o heal h assessmen ques ionnai e o heuma oid
a h i is, in he MD g oups. One s udy epo ed a
educ ion in he 28 join coun disease ac i i y
sco e o heuma oid a h i is o he MD g oup.
25
In Spain, i was obse ed ha a 10-poin
inc ease in he adhe ence o he Spanish Food
Py amid ecommenda ions was associa ed wi h a
14%(odds a io [OR] ¼0.86; 95%CI: 0.79-0.94)
lowe odds o obesi y in men. The odds o abdom-
inal obesi y also dec eased globally by 12%
(OR ¼0.88; 95%CI: 0.84-0.93).
26
As was men ioned p e iously, di e en e -
sions o he MD exis in he Medi e anean egion
a p esen . Resea che s ha e used di e en
indices o cha ac e ize he di e en MD pa e ns
employing some imes di e en ood g oups in
each. In 28 s udies included in 6 me a-analyses
e alua ing he ela ion be ween he MD die a y
pa e n and p ima y p e en ion o CVDs, some
ypical oods we e iden i ied.
27
Table 1 shows
10 such indices and hei associa ed ood g oups.
The 10 a p io i indexes a e Med,
14
m-Med,
15
a-Med,
28
-Med,
29
MAI,
30
MDS,
31
PREDIMED
sco e,
32
sco e acco ding o Be oia,
33
I alian
Medi e anean Index,
34
and sco e acco ding o
Yau and Hankey.
35
In child en, he KIDMED index
36
was he mos
widely used sco e o assess adhe ence o he MD.
37
New No dic Die
E idence on he heal h bene i s o he NND a e
less abundan han he MD. Howe e , he die a y
componen s o he NND bene i om a well-
es ablished and subs an ial e idence o heal h-
p omo ing p ope ies.
12
Recen in es iga ions
in o he associa ions be ween he local e sions
Hachem e al S89
Table 1. Selec ed Sco es o Measu ing he Adhe ence o he Medi e anean Die and Thei Co esponding Foods/Food G oups.
Index Re e ence Ce eals
Whole
g ains M/S PþM/S Vege ables Oli e oil Legumes F ui s Nu s Fish Mea Dai y Alcohol Wine
Suga swee ened
be e ages
-Med (T ichopoulou e al,
2003)
þþþþþþþþ
m-Med (T ichopoulou e al,
2005)
þþþþþþ*
a-Med (Fung e al, 2005) þþ þ þþþþ þ
-Med (Buckland e al, 2009) þþþþþþþþ
MAI (Albe i-Fidanza e al,
1999)
þþþþþþþ
MDS (Panagio akos e al,
2006)
þþþþþþþ
PREDIMED sco e (Sch ode e al, 2011) þþþþþþ þ 
Be oia sco e (Be oia e al, 2014) þþþ þþþþþ
I alian Medi e anean
index
(Agnoli e al, 2011) þþþþþþþ
Yau and Hankey
sco e
(Yau and Hankey,
2011)
þþþþþþþþ 
Abb e ia ions: MAI, Medi e anean Adequacy Index; MDS, Medi e anean Die Sco e.
S90
o he NND and heal h ou comes show an in e se
ela ionship wi h se e al ca dio ascula isk ac-
o s,
38
abdominal obesi y,
39
body a ,
40
in lam-
ma o y ma ke s and se um lipids,
41
colo ec al
cance isk,
42
and o al mo ali y.
43
Adhe ence o he NND has been shown o
lowe cause-speci ic mo ali y among Swedish
women
44
and acili a e op imal ges a ional weigh
gain and e al g ow h
45
in No wegian women pa -
icipa ing in he Mo he and Child Coho S udy.
O he s udies ha e shown ha adhe ence o a
heal hy No dic ood index was in e sely associ-
a ed wi h he isk o ype 2 diabe es
46
and ha
NDD imp o es blood p essu e, choles e ol, and
iglyce ides in compa ison o a con ol die .
47
Sus ainabili y
In e es in he ela ionship be ween die s and sus-
ainabili y is no new. I goes back o he la e
1980s when he case was made o he need o
conside en i onmen al conce ns and he p o ec-
ion o na u al esou ces in die a y guidelines.
48
This idea was e i ed in 2010 by FAO ha ga e a
de ini ion o sus ainable die s as
hose die s wi h low en i onmen al impac s which
con ibu e o ood and nu i ion secu i y and o
heal hy li e o p esen and u u e gene a ions. Sus-
ainable die s a e p o ec i e and espec ul o bio-
di e si y and ecosys ems, cul u ally accep able,
accessible, economically ai and a o dable; nu i-
ionally adequa e, sa e and heal hy; while op imiz-
ing na u al and human esou ces.
49
An impe us has been gi en again o he impo ance
o consump ion in sus ainabili y discussions ol-
lowing he Second In e na ional Con e ence on
Nu i ion
5
ha highligh ed he ole o die a y con-
sump ion in he mal unc ioning o ou ood sys-
ems. This ecogni ion ose o a highe le el wi h
he adop ion o he 2030 Sus ainable De elopmen
agenda. While he FAO de ini ion p o ided a hol-
is ic amewo k o analysis, whe e die s’ sus ain-
abili y was conside ed in i s con ibu ion o heal h
and nu i ion, economic, and sociocul u al aspec s
while p ese ing he en i onmen , he lack o
guiding p inciples o ope a ionalizing he concep
and he associa ed indica o s needed o his o
happen made using he concep e y complica ed,
especially o coun ies.
The ollowing sec ion will ocus on he indi-
ca o s o use in assessing he sus ainabili y o
die s, conside ing he 3 dimensions o sus ainabil-
i y: en i onmen al, social, and economic.
Rele an Indica o s
In o de o assess he sus ainabili y o die s, an
indica o amewo k is necessa y. Rele an indi-
ca o s need o ep esen he whole sys em and
iden i y ade-o s. In his espec , an in e na ion-
ally acknowledged indica o amewo k is he
SDG indica o amewo k.
The i s global-scale analysis quan i ying he
pe o mance o na ional ood sys em o 156 coun-
ies, conside ed 7 dimensions o sus ainabili y
(nu i ion, en i onmen , ood a o dabili y and
a ailabili y, sociocul u al well-being, esilience,
ood sa e y, and was e) employing 25 sus ainabil-
i y indica o s ac oss di e en dimensions.
50
Recen ly, a wo kshop ha b ough oge he 23
in e na ional en i onmen al oo p in expe s
om 17 ins i u ions de ined an en i onmen al
oo p in amily ela ing o he plane a y bound-
a ies concep . As a esul , a pape
51
was p oduced
de ining which oo p in indica o s a e ele an
o a oo p in amily (Figu e 1) and cla i ying
he di e ence be ween p essu e and impac indi-
ca o s, as indica ed by 2 o he s udies.
54,55
The
o me quan i ies esou ce use and/o pollu ion,
like ca bon o wa e oo p in s (WF). The la e
quan i ies impac , such as wa e s ess.
56
En i-
onmen al oo p in s a e hus p essu e indica o s
bu can include in a second s age an impac
assessmen . Li e cycle assessmen (LCA) is gen-
e ally impac -o ien ed, al hough i also has an
in en o y s age. In 2018, a s udy
57
conduc ed he
i s global assessmen o he ela ion o he ood
sys em wi h 5 o hese oo p in s (ca bon, land,
wa e , N, and P). Foo p in s ha e he ad an age
ha hey measu e p essu e along he whole sup-
ply chain, up o he consume le el. They can
he e o e be used o assess en i onmen al sus ain-
abili y o whole die s, no only p oduc s.
To measu e en i onmen al and social sus ain-
abili y, Tables 2 and 3 p opose a lis o ele an
indica o s wi hin hese 2 dimensions o
Hachem e al S91

sus ainabili y. Rele an indica o s on economic
sus ainabili y include ood a o dabili y, po e y
index, o income equali y.
50
Such a lis can be
ex ended wi h many mo e indica o s. Bu selec ion
needs o occu on (1) ele ance, (2) possibili y o
quan i ica ion/measu emen , and (3) assessmen o
ade-o s be ween indica o s. I is no ed ha only
ce ain indica o s a e also SDG indica o s, whe eas
some (in)di ec ly ela e o speci ic SDG indica o s.
Some o hese indica o s ha e al eady been
included in na ional ood-based die a y guidelines
(FBDG) as in he e ised FBDG o he Ne he -
lands
63
and Flande s (Belgium),
64
which include
indica o s pe cei ed as impo an by consume s
and a e easy o communica e like ca bon and WFs
and animal wel a e.
Sus ainabili y Assessmen o he MD and
NND
Sus ainabili y o he MD. In gene al, he MD is
associa ed wi h lowe en i onmen al p essu es
in ela ion o o he heal hy die s con aining mea
bu no when compa ed o pesce a ian o ege a -
ian die s.
A s udy
65
assessed he WF ela ed o ood con-
sump ion in 13 Medi e anean ci ies, o he cu -
en die and 3 die scena ios (MD including mea ,
pesce a ian, and ege a ian die s based on MD).
An MD leads o WF educ ions o 19% o 43%
wi h espec o he cu en die . A pesce a ian and
ege a ian die scena ios lead o WF educ ions o
28% o 52%and 30% o 53%, espec i ely. Bo h
g een and blue wa e componen s a e included.
Fo hese componen s sepa a ely, consis en
educ ions a e obse ed bu a e bigge o g een
as compa ed o blue wa e . Fo Anka a and Is an-
bul, he o al WF o he MD (3090 li e s pe capi a
pe day o l/cap/d) is signi ican ly lowe as com-
pa ed o he die ecommended by na ional Tu k-
ish FBDG (4115 l/cap/d).
Ano he s udy
66
quan i ied he WF ela ed o
ood consump ion in he EU Sou h zone (Po u-
gal, Spain, I aly, Slo enia, C oa ia, G eece,
Mal a, Cyp us), o cu en die s and 3 die sce-
na ios (MD including mea and ege a ian die
based on MD). Wi h espec o cu en die s, he
Figu e 1. A, Plane a y bounda ies (S e en e al, 2015)
52
wi h indica ion ele ance o en i onmen al oo p in
indica o s, as displayed in (Vanham e al, 2019) and (B) DPSIR (D i e -P essu e-S a e-Impac -Response) amewo k
(OECD, 2003)
53
and i s ela ionship wi h p essu e and impac indica o s, adap ed om (Vanham e al, 2019).
S92 Food and Nu i ion Bulle in 41(2S)
Table 2. Selec ed Indica o s Tha A e Rele an o Measu e he En i onmen al Sus ainabili y o Die s/ he Food Sys em.
a
Indica o Rele ance
Lis ed in
(Chaudha y
e al, 2018)
Lis ed in (Vanham e al, 2019)—
only en i onmen al
sus ainabili y
Rele an
o c ops
Rele an
o
li es ock
p oduc s
Rele an o ishe ies
p oduc s (wild ca ch)
Rele an o ishe ies p oduc s
(aquacul u e)
GHG emissions (ca bon
o GHG oo p in )
Clima e change Yes Yes Yes Yes Yes (Pa ke e al, 2018)
58
Yes
Wa e oo p in Limi ed amoun o wa e
esou ces a ailable
Yes, only blue
wa e
oo p in
Yes, bo h blue and g een wa e
oo p in
Yes Yes Limi ed, gene ally wa e use
o ene gy used along
he supply chain
(especially uel)
Yes, h ough pond e apo a ion
( eshwa e ish) and wa e o
eed and ene gy (Pahlow e al,
2015)
59
Land oo p in /
ecological oo p in
Limi ed amoun o
ag icul u al land,
de o es a ion
Yes Yes Yes Yes Limi ed, gene ally land use
o ene gy used along
he supply chain
(especially uel)
Yes, h ough land o eed and
ene gy
Ni ogen oo p in N pollu ion No Yes Yes Yes Limi ed, when bio uels a e
used as uel
Yes, h ough eed and ene gy
Phospho us oo p in P as esou ce and pollu ion No Yes Yes Yes Limi ed, when bio uels a e
used as uel
Yes, h ough eed and ene gy
Chemical oo p in Chemical pollu ion,
including om pes icides
(insec icides and
he bicides)
No Yes Yes Yes No Yes
Biodi e si y oo p in Biodi e si y is a esou ce.
Cu en ly high a e o
biodi e si y loss (WWF,
2018)
60
Yes, as land
use–
induced
biodi e si y loss Yes, biodi e si y is lis ed as
biodi e si y loss as
impac
Yes
Yes Yes Yes
Non enewable ene gy
use
Clima e change Yes No, speci ic o e lap wi h ca bon
oo p in . Al e na i ely, o al
ene gy could be used as
indica o
Yes Yes Yes Yes
Fishe ies maximum
sus ainable yield, as,
eg, measu ed by
(STECF, 2018)
61
O e ishing o ish s ocks
and o he aqua ic
animals s ocks
No No No No Yes No
Ecosys em s a us P essu e on ecosys ems,
biodi e si y loss
Yes No Yes Yes Yes Yes
a
Selec ion based upon ele ance and abili y o quan i y/measu e. The ele ance o each indica o o he p oduc ion o c ops, li es ock p oduc s, wild ishe ies, and aquacul u e is gi en.
S93
Table 3. Selec ed Indica o s Tha A e Rele an o Measu e he Social Sus ainabili y o Die s/ he Food Sys em.
a
Indica o Rele ance
Lis ed in
(Chaudha y
e al, 2018)
Rele an
o c ops
Rele an
o
li es ock
p oduc s
Rele an o ishe ies
p oduc s (wild ca ch)
Rele an o
ishe ies
p oduc s
(aquacul u e)
Animal heal h and wel a e An inc easing numbe o consume s a e
sensi i e o his issue
Yes No Yes Po en ially (only du ing
ca ch). Also o byca ch
(eg, dolphins,
u les, ...)
Yes
Use o an ibio ics O e use o an ibio ics. Inc ease in
an ibio ic esis ance (Jø gensen e al.,
2018)
62
wi h g ea isk o public heal h
No No Yes No Yes
Candida es: Gende equi y, ex en o child labo ,
espec o communi y igh s as desc ibed in
(Chaudha y e al, 2018), ood sel -su iciency;
Global Sla e y Index (GSI), a na ional-le el
indica o , as a p oxy o mode n sla e y and
labou abuses in ishe ies (Tickle e al,
2018), ...
a
Selec ion based upon ele ance and abili y o quan i y/measu e. The ele ance o each indica o o he p oduc ion o c ops, li es ock p oduc s, wild ishe ies and aquacul u e is gi en.
This lis does no include nu i ion indica o s.
S94
WF dec eases by 30% o an MD and by 41%
o a ege a ian die , when g een and blue WF
a e conside ed. Fo only he blue WF componen ,
he educ ions a e 26%and 36%, espec i ely.
A new assessmen o 9 coun ies—Spain,
F ance, I aly, G eece, Tu key, Egyp , Tunisia,
Alge ia, and Mo occo— inds ha he MD
educes he WF o he Eu opean coun ies and
Tu key wi hin he ange o 18% o 35%. Wi hin
he Magh eb coun ies and Egyp , he MD WF is
qui e simila o cu en die s WF, bu he p opo -
ions o ood p oduc g oups di e .
67
A s udy
68
compa ed he WF o he MD wi h
he Ame ican die as ecommended by he Uni ed
S a es Depa men o Ag icul u e, wi h applica-
ion o Spain and he USA. The Ame ican die
showed a 29%highe WF in compa ison wi h he
MD, ega dless o p oduc s’ o igin. The esea ch-
e s used blue, g een, and g ay WF.
A g oup o esea che s
69
ound ha adhe ence
o he MD in Spain would educe g eenhouse gas
emissions (72%), land use (58%), ene gy con-
sump ion (52%), and o a lowe ex en wa e con-
sump ion (33%). The ish and sea ood g oup was
no conside ed in he wa e and land use oo p in s
because i was assumed ha all ish is wild ca ch.
Fo he ene gy and ca bon oo p in s, his ood
g oup was conside ed. Ano he s udy
70
es ima ed
ha he shi om a mode n I alian die o an MD
would educe he ca bon oo p in by 30%, he
ecological oo p in by 24%, and he WF by 18%.
In he case o he Ne he lands, a s udy
71
ound
ha he MD has a 6%lowe ca bon oo p in and
17%lowe land oo p in han he die ecom-
mended by he 2006 Du ch Die a y Guidelines.
Vege a ian and egan die s, on he o he hand,
had lowe en i onmen al p essu es han he MD.
Fo I aly, and compa ing o a heal hy die acco d-
ing o he na ional die a y guidelines, a s udy
72
showed ha he ene gy and ca bon oo p in s o he
MD a e 4%and 5%lowe , espec i ely, han he
ecommended heal hy die . A ege a ian die had
ca bon oo p in 7%lowe han he MD.
Taking global wa ming po en ial and biodi e -
si y loss sco es as c i e ia, a s udy
73
ound ha a
egan die a es be e han an MD on bo h.
Sus ainabili y o he NND. In gene al, he NND is
associa ed wi h lowe en i onmen al p essu es
and/o impac s in ela ion o o he heal hy die s
con aining mea bu no when compa ed o pes-
ce a ian o ege a ian die s.
A s udy
74
assessed he WF ela ed o ood con-
sump ion in 9 No dic ci ies, o he cu en die
and 3 die scena ios (NND including mea , pes-
ce a ian, and ege a ian die s). An NND leads o
WF educ ions o 9% o 24%wi h espec o he
cu en die . A pesce a ian die leads o WF
educ ions o 29% o 37%. A ege a ian die leads
o WF educ ions o 36% o 44%. Bo h g een and
blue wa e componen s a e included.
In Denma k, a s udy
75
calcula ed he ca bon
oo p in o 3 die s: he A e age Danish Die
(ADD), a die based on he No dic Nu i ion Rec-
ommenda ions (NNR),
76
and a die based on he
NND. All 3 die s we e adjus ed o con ain a simila
ene gy and p o ein con en . Fo all scena ios, aking
in o accoun ood anspo o no (locally p oduced
e sus impo ed ood), o aking in o accoun a high
ac ion o o ganic ag icul u e in he NNR o no ,
he ca bon oo p in o he NND and NNR we e
lowe han o he cu en Danish die .
Ano he s udy
77
e alua ed he en i onmen al
impac o he ADD and NND, by means o 16 en i-
onmen al impac ca ego ies (LCA) which we e
mone ized o e alua e he o e all socioeconomic
e ec o a shi om an ADD o an NND. Th ee
ea u es—composi ion, anspo ( a e o impo ),
and ype o p oduc ion (con en ional o o ganic,
he la e being o a high le el cha ac e is ic o he
NND)—we e sepa a ely in es iga ed. When bo h
die composi ion and anspo we e aken in o
accoun , he NND educed he en i onmen al
impac ela i e o he ADD measu ed by all 16
impac ca ego ies. Choosing he NND esul s in a
cos sa ing o 32%o he o e all en i onmen al
cos o 835 €/pe son/yea associa ed wi h he ADD.
This educ ion is mainly d i en by educed mea
consump ion bu highe quali y mea consump ion
and less impo ed commodi ies om long dis ance.
When he ac ual 8%con en o o ganic p oduce in
he ADD and he 84%con en o o ganic p oduce in
he NND we e also aken in o accoun , he NND
educed he en i onmen al impac ela i e o he
ADD on only 10 o he 16 impac ca ego ies,
whe eas 6 inc eased. Fo he la e scena io, he
socioeconomic impac o choosing NND esul ed
in 5%(42 €/pe son/yea ) educ ion in he o e all
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