Results

Identified FBDG documents

A total of 38 FBDGs from European countries were identified (Supplemental Figure 1). Of these, 2 were excluded because the source documents were not accessible (Bosnia and Herzegovina and North Macedonia). Of the remaining 36, 33 included consumer-facing FBDGs, 10 included documents for HCPs, and 18 countries included more extensive scientific evaluation source documents. Of these, 5 countries included all 3 types of FBDG documents, 2 included consumer and HCP documents, and 13 included consumer and background documents. The geographic distribution of countries with consumer-facing FBDGs mentioning “sustainability” or a related term is shown in Figure 1. The mean year of publication of consumer-facing FBDGs mentioning sustainability or a related concept was 2021, whereas that of FBDGs not referring to sustainability was 2015. Among consumer-facing FBDG documents, references to sustainability or related concepts were more common in those published since 2020 (n = 19) than in earlier documents (n = 14). Specifically, 14 of the 19 FBDGs published since 2020 (73.7%) referred to environmental sustainability or a similar concept, compared with 6 of the 14 FBDGs (42.8%) released before 2020.

FIGURE 1: Map of European consumer-facing food-based dietary guidelines (FBDGs) with mention of environmental sustainability or a similar term (n = 33). Stripes indicate a publication date before 2020.

Presence of sustainability criteria in FBDG documents

Across all document types, the messages “Minimize environmental impact and preserve biodiversity” (direct mention: 46% in consumer, 70% in HCP, 89% in background documents) and “Reduce consumption of animal-based foods/animal protein and increase plant protein/plant-based foods” (46%, 50%, and 72%, respectively) were the most frequently included with reference to environmental sustainability (Table 1). In both consumer-facing and HCP documents, “Fruits and vegetables: locally produced” (42% and 40%, respectively) was also among the most frequently mentioned messages with regard to sustainability, along with “Fruits and vegetables: choose from seasonal sources” in consumer-facing documents (42%). As seen in Table 1, consumer and HCP materials typically included fewer explicit sustainability-related messages (4.97 and 3.70 criteria, respectively), compared with scientific background documents (9.06 criteria with explicit mention of sustainability, on average).

Criteria | Consumer documents (n = 33) | HCP documents (n = 10) | Scientific background documents (n = 18)
Explicit message | General message | Not mentioned | Explicit message | General message | Not mentioned | Explicit message | General message | Not mentioned
Diverse food consumption | 8 (24.2) | 23 (69.7) | 2 (6.1) | 1 (10.0) | 8 (80.0) | 1 (10.0) | 8 (44.4) | 5 (27.8) | 5 (27.8)
Reduce processed meat consumption | 13 (39.4) | 15 (45.5) | 5 (15.2) | 1 (10.0) | 8 (80.0) | 1 (10.0) | 9 (50.0) | 7 (38.9) | 2 (11.1)
Reduce red meat consumption | 11 (33.3) | 14 (42.4) | 8 (24.2) | 2 (20.0) | 6 (60.0) | 2 (20.0) | 12 (66.7) | 4 (22.2) | 2 (11.1)
Limit processed and HFSS foods | 8 (24.2) | 24 (72.7) | 1 (3.0) | 2 (20.0) | 8 (80.0) | 0 (0.0) | 12 (66.7) | 5 (27.8) | 1 (5.6)
Hydration: water as fluid of choice, choose water over soft drinks | 10 (30.3) | 21 (63.6) | 2 (6.1) | 1 (10.0) | 8 (80.0) | 1 (10.0) | 10 (55.6) | 5 (27.8) | 3 (16.7)
Dairy: moderate consumption | 4 (12.1) | 4 (12.1) | 25 (75.8) | 2 (20.0) | 2 (20.0) | 6 (60.0) | 11 (61.1) | 1 (5.6) | 6 (33.3)
Consume dairy alternatives | 4 (12.1) | 2 (6.1) | 27 (81.8) | 1 (10.0) | 3 (30.0) | 6 (60.0) | 2 (11.1) | 6 (33.3) | 10 (55.6)
Increase wholegrains | 12 (36.4) | 20 (60.6) | 1 (3.0) | 2 (20.0) | 8 (80.0) | 0 (0.0) | 10 (55.6) | 6 (33.3) | 2 (11.1)
Reduce food loss and waste | 11 (33.3) | 3 (9.1) | 19 (57.6) | 2 (20.0) | 2 (20.0) | 6 (60.0) | 13 (72.2) | 0 (0.0) | 5 (27.8)
Reduce consumption of animal-based foods, reduce animal protein, increase plant protein, increase plant-based foods | 15 (45.5) | 14 (42.4) | 4 (12.1) | 5 (50.0) | 3 (30.0) | 2 (20.0) | 13 (72.2) | 3 (16.7) | 2 (11.1)
Prefer sustainably sourced fish | 13 (39.4) | 1 (3.0) | 19 (57.6) | 3 (30.0) | 0 (0.0) | 7 (70.0) | 11 (61.1) | 0 (0.0) | 7 (38.9)
Adequate nutrition, limit overconsumption | 3 (9.1) | 16 (48.5) | 14 (42.4) | 1 (10.0) | 5 (50.0) | 4 (40.0) | 6 (33.3) | 5 (27.8) | 7 (38.9)
Animal production: minimize antibiotics and hormones | 0 (0.0) | 0 (0.0) | 33 (100.0) | 0 (0.0) | 0 (0.0) | 10 (100.0) | 2 (11.1) | 0 (0.0) | 16 (88.9)
Minimize food packaging | 6 (18.2) | 1 (3.0) | 26 (78.8) | 0 (0.0) | 0 (0.0) | 10 (100.0) | 6 (33.3) | 0 (0.0) | 12 (66.7)
Minimize environmental impact, biodiversity preservation | 15 (45.5) | 0 (0.0) | 18 (54.5) | 7 (70.0) | 0 (0.0) | 3 (30.0) | 16 (88.9) | 0 (0.0) | 2 (11.1)
Fruits and vegetables: choose from seasonal | 14 (42.4) | 9 (27.3) | 10 (30.3) | 3 (30.0) | 3 (30.0) | 4 (40.0) | 8 (44.4) | 2 (11.1) | 8 (44.4)
Fruits and vegetables: locally produced | 14 (42.4) | 7 (21.2) | 12 (36.4) | 4 (40.0) | 2 (20.0) | 4 (40.0) | 11 (61.1) | 1 (5.6) | 6 (33.3)
Recycle food waste | 3 (9.1) | 0 (0.0) | 30 (90.9) | 0 (0.0) | 0 (0.0) | 10 (100.0) | 3 (16.7) | 0 (0.0) | 15 (83.3)

In comparison to messages related to protein sources or wholegrain intake, consumer-facing FBDGs rarely addressed dairy consumption with respect to sustainability (i.e., recommendations to moderate dairy intake or to consume dairy alternatives were only present in 24.2% and 18.2% of documents, respectively). Supplemental Table 3 provides these detailed numbers for each criterion from the 2 sets, separately (FAO and BDA).

Figure 2 presents the total number of mentions for each message, distinguishing those with explicit mention of environmental sustainability in green and those with general environmental sustainability messaging in grey. This figure illustrates that a higher proportion of criteria were included with direct reference to sustainability in background documents compared with consumer and HCP documents across all 18 criteria. Overall, across the 18 criteria, explicit mentions of environmental sustainability were found in 28% of consumers FBDGs, 21% of HCP FBDGs, and 51% of background documents.

FIGURE 2: Total number of mentions for each criterion (grey area), of which explicit sustainability mentions are shown in green. (A) Consumer documents (n = 33). (B) Health care professional documents (n = 10). (C) Background documents (n = 18).

The criteria mentioned least frequently across all document types were “Recycle food waste” (explicit mention of environmental sustainability: 9% in consumer, 0% in HCP, 17% in background) and “Animal production: minimize antibiotics and hormones” (0%, 0%, and 11%, respectively). In contrast, consumer and HCP documents more often included general criteria without reference to sustainability, particularly “Diverse food consumption” (general mention: 70% in consumer, 80% in HCP documents) and “Limit processed foods and HFSS foods” (73% and 80%, respectively).

FBDG recommendations for pulses and meat and their alignment with sustainability criteria

Notable differences emerged in the median recommended daily amounts of meat and pulses depending on the type of guidance provided. Figure 3 presents the recommended daily intakes for total meat, red and processed meat, and pulses according to the inclusion of various criteria. In FBDGs using messages related to increasing either plant-based protein or plant-based foods (Figure 3A), the recommended total meat intake was substantially higher when the criterion was not mentioned (62.3 g/d) compared with guidelines using a general message (45.0 g/d) or those explicitly referring to environmental sustainability (42.9 g/d). In contrast, recommended intakes for pulses were higher when either criterion (increase plant-based protein or increase plant-based foods) was mentioned (50 g/day) than when they were not (35.5 g/d) and were highest in guidelines including a general message (71.4 g/d).

FIGURE 3: Recommended amounts per day for total meat, red and processed meat, and pulses, and sustainability criteria inclusion in consumer-facing food-based dietary guidelines. Numbers above columns indicate sample size. (A) Increase plant-based foods/protein. (B) Reduce animal foods/protein. (C) Reduce red meat. (D) Reduce processed meat.

For FBDGs including “reducing animal foods/animal protein,” the recommended amounts for total meat and for red and processed meat varied little, although recommendations for pulses were higher in guidelines in which the criterion was not mentioned (Figure 3B).

Across documents that included messages targeting a limitation or reduction of red meat intake, recommendations showed higher total meat intakes, lower red meat intakes, and higher pulse intakes compared with guidelines that did not include such messages (Figure 3C). Finally, in FBDGs recommending limiting or reducing processed meat intake (Figure 3D), the recommended daily intake of total meat was higher, while the recommendations for red and processed meat, as well as for pulses, were lower compared with guidelines that did not mention this criterion.