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      Effect of food-related behavioral activation therapy on food intake and the environmental impact of the diet: results from the MooDFOOD prevention trial

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          Food-based dietary guidelines are proposed to not only improve diet quality, but to also reduce the environmental impact of diets. The aim of our study was to investigate whether food-related behavioral activation therapy (F-BA) applying Mediterranean-style dietary guidelines altered food intake and the environmental impact of the diet in overweight adults with subsyndromal symptoms of depression.


          In total 744 adults who either received the F-BA intervention (F-BA group) or no intervention (control group) for 12 months were included in this analysis. Food intake data were collected through a food frequency questionnaire at baseline and after 6 and 12 months. Greenhouse gas emissions (GHGE), land use (LU), and fossil energy use (FEU) estimates from life-cycle assessments and a weighted score of the three ( pReCiPe score) were used to estimate the environmental impact of each individual diet at each timepoint.


          The F-BA group reported increased intakes of vegetables (19.7 g/day; 95% CI 7.8–31.6), fruit (23.0 g/day; 9.4–36.6), fish (7.6 g/day; 4.6–10.6), pulses/legumes (4.0 g/day; 1.6–6.5) and whole grains (12.7 g/day; 8.0–17.5), and decreased intake of sweets/extras (− 6.8 g/day; − 10.9 to − 2.8) relative to control group. This effect on food intake resulted in no change in GHGE, LU, and pReCiPe score, but a relative increase in FEU by 1.6 MJ/day (0.8, 2.4).


          A shift towards a healthier Mediterranean-style diet does not necessarily result in a diet with reduced environmental impact in a real-life setting.

          Trial registration

          ClinicalTrials.gov. Number of identification: NCT02529423. August 2015.

          Electronic supplementary material

          The online version of this article (10.1007/s00394-019-02106-1) contains supplementary material, which is available to authorized users.

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          Most cited references 31

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          Climate Change and Food Systems

          Food systems contribute 19%–29% of global anthropogenic greenhouse gas (GHG) emissions, releasing 9,800–16,900 megatonnes of carbon dioxide equivalent (MtCO2e) in 2008. Agricultural production, including indirect emissions associated with land-cover change, contributes 80%–86% of total food system emissions, with significant regional variation. The impacts of global climate change on food systems are expected to be widespread, complex, geographically and temporally variable, and profoundly influenced by socioeconomic conditions. Historical statistical studies and integrated assessment models provide evidence that climate change will affect agricultural yields and earnings, food prices, reliability of delivery, food quality, and, notably, food safety. Low-income producers and consumers of food will be more vulnerable to climate change owing to their comparatively limited ability to invest in adaptive institutions and technologies under increasing climatic risks. Some synergies among food security, adaptation, and mitigation are feasible. But promising interventions, such as agricultural intensification or reductions in waste, will require careful management to distribute costs and benefits effectively.
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            Analysis and valuation of the health and climate change cobenefits of dietary change.

            What we eat greatly influences our personal health and the environment we all share. Recent analyses have highlighted the likely dual health and environmental benefits of reducing the fraction of animal-sourced foods in our diets. Here, we couple for the first time, to our knowledge, a region-specific global health model based on dietary and weight-related risk factors with emissions accounting and economic valuation modules to quantify the linked health and environmental consequences of dietary changes. We find that the impacts of dietary changes toward less meat and more plant-based diets vary greatly among regions. The largest absolute environmental and health benefits result from diet shifts in developing countries whereas Western high-income and middle-income countries gain most in per capita terms. Transitioning toward more plant-based diets that are in line with standard dietary guidelines could reduce global mortality by 6-10% and food-related greenhouse gas emissions by 29-70% compared with a reference scenario in 2050. We find that the monetized value of the improvements in health would be comparable with, or exceed, the value of the environmental benefits although the exact valuation method used considerably affects the estimated amounts. Overall, we estimate the economic benefits of improving diets to be 1-31 trillion US dollars, which is equivalent to 0.4-13% of global gross domestic product (GDP) in 2050. However, significant changes in the global food system would be necessary for regional diets to match the dietary patterns studied here.
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              Importance of food-demand management for climate mitigation


                Author and article information

                Eur J Nutr
                Eur J Nutr
                European Journal of Nutrition
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                23 October 2019
                23 October 2019
                : 59
                : 6
                : 2579-2591
                [1 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, , Vrije Universiteit (VU) Amsterdam, ; De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
                [2 ]GRID grid.491176.c, ISNI 0000 0004 0395 4926, Netherlands Nutrition Centre (Voedingscentrum), ; Bezuidenhoutseweg 105, 2594 AC The Hague, The Netherlands
                [3 ]GRID grid.9563.9, ISNI 0000 0001 1940 4767, Institut Universitari d’Investigació en Ciències de la Salut (IUNICS/IDISBA), Rediapp, , University of Balearic Islands, ; Carretera De Valldemossa km 7.5, 07122 Palma de Mallorca, Spain
                [4 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Psychiatry, Amsterdam Public Health Research Institute, and GGZ inGeest Specialized Mental Health Care, , Amsterdam UMC, VU Amsterdam, ; De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
                [5 ]GRID grid.9647.c, ISNI 0000 0004 7669 9786, Department of Psychiatry and Psychotherapy, Medical Faculty, , University Leipzig, ; Semmelweisstr. 10, Haus 13, 04103 Leipzig, Germany
                [6 ]GRID grid.7839.5, ISNI 0000 0004 1936 9721, Department of Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, , Goethe-University Frankfurt, ; Heinrich-Hoffmann-Str. 10, 60528 Frankfurt a.M., Germany
                [7 ]GRID grid.8391.3, ISNI 0000 0004 1936 8024, Department of Psychology, , University of Exeter, ; Perry Road, Exeter, EX4 4QG UK
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funded by: FP7-KBBE
                Award ID: 613598
                Original Contribution
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Nutrition & Dietetics

                rct, diet, sustainability, depression


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