Estimated micronutrient shortfalls of the EAT–Lancet planetary health diet

From a nutritional perspective, the preferred way to fill micronutrient gaps is primarily through minimally processed, intrinsically nutrient-dense foods. This is the preferred approach because foods are more than the sum of a handful of well known nutrients. In fact, foods contain thousands of compounds bound in a food matrix, which together can positively influence metabolism and health (eg, through nutrient absorption, satiety, and the immune system).

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van Vliet S
Kronberg SL
Provenza FD

Plant-based meats, human health, and climate change.

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Barabási A-L

Menichetti G

Loscalzo J

The unmapped chemical complexity of our diet.

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Food, not nutrients, is the fundamental unit in nutrition.

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The food matrix: implications in processing, nutrition and health.

Given the potential micronutrient shortfalls of the EAT–Lancet planetary health diet, important changes might be required to achieve dietary micronutrient adequacy for adults without relying on fortification and supplementation. Most importantly, we found that to achieve a micronutrient adequate diet that is also more feasible at the population level would probably require increasing animal source foods from 14% of total kcal to 27% of total kcal, reducing dietary phytate from 1985 mg to 1021 mg to improve iron and zinc absorption, and allowing a 3:1 ratio of whole to refined grains (table; appendix pp 2–3). This modified diet would increase daily intake of tubers and starchy vegetables by 161 kcal, increase daily intake of fish and shellfish (including bivalves and crustaceans) by 105 kcal, increase daily intake of eggs by 60 kcal, increase daily intake of beef by 45 kcal, increase daily intake of chicken and other poultry by 30 kcal, and increase daily intake of pork by 15 kcal. Furthermore, the modified diet would add an average daily intake of refined grains of 100 kcal, add a daily intake of seeds of 100 kcal, and add a daily intake of organ meats of 8 kcal (table). To make room for these increases and enable an isocaloric diet, the modified diet would reduce daily intake of whole grains by 511 kcal, reduce daily intake of pulses by 136 kcal, reduce daily intake of tree nuts by 124 kcal, reduce daily intake of peanuts by 117 kcal, and reduce daily intake of soy foods by 12 kcal (table). These modifications are intended to illustrate relatively feasible dietary shifts that help achieve nutrient adequacy but are not intended to optimally minimis risk of NCDs, environmental effects, or unaffordability. For women of reproductive age, achieving adequate iron intakes without fortified foods or supplements can be particularly challenging and would require adherence to very high intakes of iron-rich foods and few, if any, junk foods.

TableEAT–Lancet healthy reference diet and hypothetical micronutrient adequate diet for adults (25 years and older) for EAT– Lancet planetary health diet food groups and additional food groups

Although it is possible for individuals on a variety of dietary patterns to meet micronutrient requirements through the consumption of foods that are intrinsically dense in micronutrients, factors in the food environment, including personal preferences, nutritional knowledge, socioeconomic status, convenience, access, and affordability might hinder diet quality to varying degrees globally depending on the context and population.

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Fanzo J

Haddad L

Schneider KR

et al.

Viewpoint: rigorous monitoring is necessary to guide food system transformation in the countdown to the 2030 global goals.

Therefore, fortification, including biofortification (ie, breeding crops to increase their nutrient value), and supplementation is seen by many as an important way to fill key nutrient gaps and prevent micronutrient deficiencies at the population level, especially for groups with increased needs. Indeed, even in high-income countries, micronutrient deficiencies among women of reproductive age are common,

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Stevens GA

Beal T

Mbuya MNN

et al.

Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual-level data from population-representative surveys.

highlighting a role for improved fortification and supplementation practices. However, while seeking to improve fortification and supplementation, it is important to simultaneously restrict the intake of energy-dense, ultra-processed foods (even if fortified), which have been linked to numerous NCDs and premature mortality.

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Lane MM

Davis JA

Beattie S

et al.

Ultraprocessed food and chronic noncommunicable diseases: a systematic review and meta-analysis of 43 observational studies.

Ultra-processed foods are currently the primary source of calories in many high-income countries,

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Lane MM

Davis JA

Beattie S

et al.

Ultraprocessed food and chronic noncommunicable diseases: a systematic review and meta-analysis of 43 observational studies.

and the consumption of these foods is increasing rapidly in low-income and middle-income countries.

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Lane MM

Davis JA

Beattie S

et al.

Ultraprocessed food and chronic noncommunicable diseases: a systematic review and meta-analysis of 43 observational studies.

Although the underlying mechanisms explaining the link between ultra-processed foods and disease are poorly understood,

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Ludwig DS

Astrup A

Bazzano LA

et al.

Ultra-processed food and obesity: the pitfalls of extrapolation from short studies.

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Eliminate or reformulate ultra-processed foods? Biological mechanisms matter.

ultra-processed foods are typically energy-dense and hyper-palatable and disrupt gut–brain signalling, which can lead to overconsumption and weight gain when they are a predominant component of the food environment.

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Hall KD

Ayuketah A

Brychta R

et al.

Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake.