Healthy diets can create environmental trade-offs, depending on how diet quality is measured

Abstract Background There is an urgent need to assess the linkages between diet patterns and environmental sustainability in order to meet global targets for reducing premature mortality and improving sustainable management of natural resources. This study fills an important research gap by evaluating the relationship between incremental differences in diet quality and multiple environmental burdens, while also accounting for the separate contributions of retail losses, inedible portions, and consumer waste. Methods Cross sectional, nationally-representative data on food intake in the United States were acquired from the National Health and Nutrition Examination Survey (2005–2016), and were linked with nationally-representative data on food loss and waste from published literature. Survey-weighted procedures estimated daily per capita food retail loss, food waste, inedible portions, and consumed food, and were summed to represent Total Food Demand. Diet quality was measured using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010. Data on food intake, loss, and waste were inputted into the US Foodprint Model to estimate the amount of agricultural land, fertilizer nutrients, pesticides, and irrigation water used to produce food. Results This study included dietary data from 50,014 individuals aged ≥2 y. Higher diet quality (HEI-2015 and AHEI-2010) was associated with greater per capita Total Food Demand, as well as greater retail loss, inedible portions, consumer waste, and consumed food (P < 0.001 for all comparisons). Consumed food accounted for 56–74% of agricultural resource use (land, fertilizer nutrients, pesticides, and irrigation water), retail loss accounted for 4–6%, inedible portions accounted for 2–15%, and consumer waste accounted for 20–23%. Higher diet quality was associated with lower use of agricultural land, but the relationship to other agricultural resources was dependent on the tool used to measure diet quality (HEI-2015 vs. AHEI-2010). Conclusions Over one-quarter of the agricultural inputs used to produce Total Food Demand were attributable to edible food that was not consumed. Importantly, this study also demonstrates that the relationship between diet quality and environmental sustainability depends on how diet quality is measured. These findings have implications for the development of sustainable dietary guidelines, which requires balancing population-level nutritional needs with the environmental impacts of food choices.