DOI: 10.5287/bodleian:xoeeb5kax
title: Supplementary data to "The healthiness and sustainability of national and global food-based dietary guidelines: a modelling study"

description: The dataset includes detailed country-level results of an analysis of national and global food-based dietary guidelines with respect to their health and environmental impacts. The abstract of the associated journal article is appended below. Objectives: To analyse the health and environmental implications of adopting national food-based dietary guidelines (FBDGs) at a national level and in comparison to global health and environmental targets. Design: We used a graded coding method to extract quantitative recommendations from 85 FBDGs, and then assessed their health and environmental impacts by using a comparative risk assessment of chronic-disease mortality and a set of country-specific environmental footprints for greenhouse gas (GHG) emissions, freshwater use, cropland use, and fertilizer application. For comparison, we also analysed the impacts of adopting global dietary recommendations of the World Health Organization (WHO) and the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. Main outcome measures and Setting: We assessed each guideline’s health and sustainability implications by modelling its adoption at both the national and global level, and comparing the impacts to global health and environmental targets, including the Non-Communicable Disease (NCD) Agenda, the Paris Climate Agreement, the Aichi Biodiversity targets related to land use, and the Sustainable Development Goals and planetary boundaries related to freshwater use and fertilizer application. Results: Adoption of national FBDGs was associated with reductions in premature mortality of 15% on average (95% uncertainty interval, 13% to 16%), and mixed changes in environmental resource demand, including a reduction in GHG emissions of 13% on average (regional range, -34% to +35%). When universally adopted globally, most of the national guidelines (83, 98%) were not compatible with at least one of the global health and environmental targets. About a third of the FBDGs (29, 34%) were incompatible with the NCD Agenda, and most (57 to 74, 67% to 87%) were incompatible with the Paris Climate Agreement and other environmental targets. In comparison, adoption of the WHO recommendations was associated with similar health and environmental changes, whilst adoption of the EAT-Lancet recommendations was associated with 34% greater reductions in premature mortality, more than three times greater reductions in GHG emissions, and general attainment of the global health and environmental targets. Conclusions: Our analysis suggests that national guidelines could be both healthier and more sustainable. Providing clearer advice on limiting in most contexts the consumption of animal source foods, in particular beef and dairy, was found to have the greatest potential for increasing the environmental sustainability of dietary guidelines, whereas increasing the intake of whole grains, fruits and vegetables, nuts and seeds, and legumes, reducing the intake of red and processed meat, and highlighting the importance of attaining balanced energy intake and weight levels were associated with most of the additional health benefits. The health results were based on observational data and assuming a causal relationship between dietary risk factors and health outcomes. The certainty of evidence for these relationships is mostly graded as moderate in existing meta-analysis.