英国牛津大学Marco Springmann团队对国家和全球基于食物的饮食指南的健康性和可持续性进行了建模研究。2020年7月15日，《英国医学杂志》发表了该成果。

为了分析在国家水平采用基于食物的饮食指南（FBDGs）对健康和环境的影响，并与全球健康和环境目标进行比较，研究组在85个国家进行了一项建模研究，开发了一种分级编码方法，从85个FBDG中提取定量建议。这些指南对健康和环境的影响，通过慢性疾病死亡的风险评估，以及针对温室气体排放、淡水使用、农田使用和化肥施用的一系列国家特定的环境影响来进行评估。

采用国家FBDGs，可使过早死亡率平均降低15%，造成环境资源需求的混合变化，其中包括温室气体排放平均减少13%。当在全球范围内普遍采用时，大多数国家指南（98％）至少与一项全球健康和环境指标不符。大约三分之一的FBDG（34％）与非传染性疾病议程不符，大多数（67%-87%）与《巴黎气候协定》和其他环境目标不符。

相比之下，采用世卫组织的建议与类似的健康和环境变化相关，而采用EAT-柳叶刀建议则可使过早死亡率降低34%以上、温室气体排放量减少3倍以上、总体实现全球健康和环境目标。例如，英国、美国和中国的FBDG与气候变化、土地利用、淡水和氮目标不符，而采用EAT柳叶刀建议的指南可将英国减少的过早死亡人数从78000人增至104000人，美国从480000人增至585000人，中国从1149000人增至1802000人。

研究分析表明，国家指南在健康性和可持续性方面仍有提升空间。在大多数情况下，限制动物源性食品，特别是牛肉和奶制品的消费，可显著提高饮食指南的环境可持续性，同时增加全谷类、水果和蔬菜、坚果和种子以及豆类的摄入量，减少红肉和加工肉的摄入，强调均衡能量摄入和保持体重水平的重要性，可使大多数人获得额外的健康益处。

附：英文原文

Title: The healthiness and sustainability of national and global food based dietary guidelines: modelling study

Author: Marco Springmann, Luke Spajic, Michael A Clark, Joseph Poore, Anna Herforth, Patrick Webb, Mike Rayner, Peter Scarborough

Issue&Volume: 2020/07/15

Abstract: Objective To analyse the health and environmental implications of adopting national food based dietary guidelines (FBDGs) at a national level and compared with global health and environmental targets.

Design Modelling study.

Setting 85 countries.

Participants Population of 85 countries.

Main outcome measures A graded coding method was developed and used to extract quantitative recommendations from 85 FBDGs. The health and environmental impacts of these guidelines were assessed by using a comparative risk assessment of deaths from chronic diseases and a set of country specific environmental footprints for greenhouse gas emissions, freshwater use, cropland use, and fertiliser application. For comparison, the impacts of adopting the global dietary recommendations of the World Health Organization and the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems were also analysed. Each guideline’s health and sustainability implications were assessed by modelling its adoption at both the national level and globally, and comparing the impacts to global health and environmental targets, including the Action Agenda on Non-Communicable Diseases, 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 fertiliser 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 greenhouse gas 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 agenda on non-communicable diseases, 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, whereas adoption of the EAT-Lancet recommendations was associated with 34% greater reductions in premature mortality, more than three times greater reductions in greenhouse gas emissions, and general attainment of the global health and environmental targets. As an example, the FBDGs of the UK, US, and China were incompatible with the climate change, land use, freshwater, and nitrogen targets, and adopting guidelines in line with the EAT-Lancet recommendation could increase the number of avoided deaths from 78000 (74000 to 81000) to 104000 (96000 to 112000) in the UK, from 480000 (445000 to 516000) to 585000 (523000 to 646000) in the USA, and from 1149000 (1095000 to 1204000) to 1802000 (1664000 to 1941000) in China.

Conclusions This 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 relation between dietary risk factors and health outcomes. The certainty of evidence for these relations is mostly graded as moderate in existing meta-analyses.

DOI: 10.1136/bmj.m2322

Source: https://www.bmj.com/content/370/bmj.m2322