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This commentary responds to the study by Kelly Garton et al., “Monitoring the impacts of international trade and investment agreements on food environments: a Canadian case study,” published in Public Health Nutrition, which applies the INFORMAS trade and investment monitoring framework to the Canadian food system.
This study aimed to determine the prevalence of Lebanese adults living with underweight, overweight, or obesity, assess and compare the cost of the Mediterranean Diet (MD) with that of the current dietary consumption pattern, and explore diet cost as a determinant of living with underweight, overweight, or obesity.
Design:
Data for this nationally-representative cross-sectional study were collected through sociodemographic questionnaires, anthropometric measurements, the Arab Family Food Security Scale, and dietary assessments using a validated food frequency questionnaire and 24-hour recalls. Diet costs were calculated based on 2023 market prices using purchasing power parity. Logistic regression was used to assess associations with BMI.
Setting:
Lebanon, using data representative of the Lebanese adults’ population
Participants:
444 Lebanese residents aged 18-64 years.
Results:
Overall, 66.2% of the participants were living with underweight (4.3%), overweight (37.8%), or obesity (24.1%). On average, the cost of following MD ranged from Intl.$ 23.36 to Intl.$ 26.49/person/day, whereas, a Lebanese adult spent Intl.$ 20.46 on consumption. Only 31.1% of participants spent an amount equal to or greater than the minimum MD cost (Intl. $23.36/day). Participants who meet or exceed this threshold were 1.59 times more likely to be living with a healthy weight (aOR=1.59, p=0.043).
Conclusions:
The high prevalence of Lebanese adults living with underweight, overweight, or obesity is compounded by the unaffordability of a healthy MD. Improving the affordability of nutritious foods is crucial to promoting healthier dietary patterns and achieving better weight outcomes. Public health strategies should include economic, behavioral, and policy-level interventions to enhance diet quality and affordability in crisis-affected populations.
This study used the Trials of Improved Practices (TIPs) approach to explore complementary feeding practices among caregivers of children under two and assess the acceptance of new nutritional supplements by providing Microbiota-Directed Supplementary Food (MDSF), Ready-to-Use Supplementary Food (RUSF), and Locally Available Food (LAF) among moderately malnourished children.
Design:
The study was conducted between May and October 2022 in preparation for a larger trial. The first phase focused on complementary feeding, hygiene, breastfeeding, and responsive feeding practices using in-depth interviews and observations. The second phase involved counseling sessions and providing food supplements for 45 participants. Follow-up visits evaluated acceptability and challenges faced during this period.
Setting:
Bauniabadh slum, Mirpur, Dhaka.
Participants:
65 children aged 6-24 months with moderate wasting and their caregivers.
Results:
Findings from IDIs and observations revealed poor handwashing practices, with most caregivers washing only with water, and inconsistent use of soap. Only a minority boiled drinking water or cleaned utensils with soap. Responsive feeding practices were also limited, with frequent mobile phone use during feeding and lack of attention to the child. Among the three food interventions, LAF received the highest hedonic ratings across all sensory attributes, with a mean taste score of 5.7±1.4, compared to MDSF (4.8±1.9) and RUSF (4.7±1.6), although median consumption was similar across all supplements (75%).
Conclusion:
The TIPs approach identified context-specific caregiver behaviours and feeding preferences. These findings will guide the upcoming trial and assist policymakers and program planners in developing culturally tailored interventions to address childhood malnutrition in urban slums.
This study examines aspects of women’s empowerment related to the nutritional status of under-five children in Bangladesh, including their age-appropriate food intake and access to healthcare during acute respiratory tract infection (ARI).
Design:
Three waves of the Bangladesh Demographic Health Survey (BDHS) data (2011, 2014, 2017-18) were pulled and utilized to construct three domains of the survey-based women’s empowerment index, such as social independence, intrinsic agency, and instrumental agency. The Height-for-Age Z (HAZ), Weight-for-Age Z (WAZ), and Weight-for-Height Z (WHZ) scores were used to measure the nutritional status of offspring. Two variables were generated to measure age-appropriate food intake and treatment-seeking from medically trained providers (MTPs) at the commencement of ARI. Generalized structural equation modelling was performed to develop pathways between women’s empowerment and children’s nutritional status.
Settings:
Data was collected from eight administrative divisions in Bangladesh.
Participants:
A total of 18706 married women aged 15-45 years residing with their husbands and having at least one under-five child.
Results:
Women’s social independence was positively associated with HAZ [0.25 (95% CI: 0.22, 0.28)], WAZ [0.21 (0.18,0.24)], WHZ [0.06 (0.02,0.09)]. Intrinsic agency positively influenced HAZ [0.03 (0.02,0.04)] and WAZ [0.02 (0.01,0.02)]. Both social independence and intrinsic agency promoted appropriate feeding, while instrumental agency had a negative effect on food consumption [-0.0026 (–0.005, –0.0002)]. Both age-appropriate food intake and seeking treatment from MTPs during recent ARI episodes improved nutritional outcomes of offspring.
Conclusion:
Maternal social independence and intrinsic agency enhance the nutritional status, food consumption, and healthcare access of offspring in Bangladesh.
To monitor the influence of international trade and investment agreements on the food environment and population nutrition in Canada.
Design:
Implementation of a revised version of the INFORMAS trade and investment monitoring protocol to guide descriptive analysis of quantitative trade and investment data over the period 1994 to 2020 as well as qualitative review of policy documents related to nutrition regulations and trade concerns.
Setting:
Canada, which has 15 trade and investment agreements in force with 51 countries as of 2024.
Results:
Extensive tariff reductions occurred in 1995 with the introduction of the World Trade Organization, with minimal tariff reductions since that time. Tariff rates were generally highest on ultra-processed focus foods, though many countries gained tariff-free access over the study period. There were large surges in imports of dairy, meats, sugars, and soft drinks after joining the WTO, while exports of grains, dairy, sugars, processed meats, ready-meals, and sauces saw substantial growth. FDI into Canada’s food manufacturing sector increased consistently, reaching $32.6 billion in 2020-2022. Canada has raised several specific trade concerns at the WTO over other countries’ nutrition labelling policies and some of the challenged policies have subsequently been abandoned, modified, or delayed.
Conclusions:
Increased trade and investment openness in Canada appears linked to changes in food imports, exports, and foreign investment that may impact the nutritional quality of food environments. Monitoring how trade agreements shape national food supplies is critical to developing trade policies that improve nutrition in alignment with public health goals at home and abroad.
Dietary patterns are increasingly recognized as crucial factors influencing the progression of MASLD. This study aimed to explore the association between dietary patterns and MASLD risk among adults, using Latent Class Analysis (LCA), to our knowledge, for the first time in this context. This cross-sectional study included 8,549 adults general population. Dietary intake data were collected using a validated Food Frequency Questionnaire (FFQ) and analyzed with Nutritionist IV software. A 3-step LCA was applied to determine distinct dietary patterns among participants using micro- and macronutrients. Liver fibrosis severity was evaluated using a validated non-invasive marker, FIB-4 Score. Our analysis identified three distinct dietary patterns, each significantly associated with the severity of liver fibrosis. Class 1(High-volume, high-fiber/mineral-rich pattern) was associated with the lowest risk of liver fibrosis. Compared to Class 1, participants in Class 2 (Moderate-volume, low-fiber/high-sodium/mineral-poor pattern) (OR = 1.24; p = 0.002) and Class 3 (Restricted-volume, nutrient-depleted pattern) (OR = 1.13; p = 0.027) had significantly higher odds of moderate-to-high liver fibrosis risk. Class-specific regression analysis showed that age and smoking were the most consistent predictors of fibrosis risk across all patterns. Dietary patterns rich in antioxidants, fiber, and essential micronutrients appear effective in reducing the risk of liver fibrosis. Further longitudinal studies are required to confirm these findings and determine practical clinical applications.
Dysregulation of fatty acids metabolism has been associated with the risk of osteoarthritis (OA), yet current evidence from epidemiological or genetic studies remains inconclusive. We aimed to investigate the phenotypic association and genetic architecture between total fatty acids (TotFA), saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and OA. Leveraging individual-level data from the UK Biobank, combined with the hitherto largest genome-wide association studies of fatty acids (N = 136 016) and OA (N = 826 690) in European individuals, we implemented a comprehensive analytical framework. This included observational and genetic analyses, incorporating phenotypic associations, genetic correlations, cross-trait meta-analysis, enrichment analysis and Mendelian randomization (MR). Observational analysis identified SFA as a risk factor, while MUFA and PUFA as protective factors for OA. Despite a lack of genome-wide genetic correlation, statistically significant local signals were detected within three specific genomic regions. Cross-trait meta-analysis identified 68 pleiotropic loci shared between fatty acids and OA, of which nine were novel. Enrichment analysis revealed the shared genes were enriched in lipoprotein metabolism, immune response, and inflammation regulation pathways. Two-sample MR provided evidence for a causal relationship of MUFA and PUFA on OA that survived false discovery rate correction. This study supports associations between circulating fatty acids and OA, with MUFA and PUFA exerting a protective role. Our findings provide new perspectives into OA prevention especially regarding the potential dietary interventions.
Various strategies across food systems are needed for a systemic change, with dietary shifts representing a meaningful pathway—particularly in high-income nations. Plant-based analogues (PBAs) that mimic animal-based foods, represent a promising strategy to facilitate such shifts because they require minimal behaviour adjustments. This review aims to synthesise nutritional, health and environmental evidence on PBAs by examining their benefits, challenges, and research gaps to inform and support evidence-based policy and practice. PBAs generally have lower greenhouse gas emissions, land use and water use than their animal-based counterparts. Nutritionally, PBAs are complex, varying across product brands, product types, processing techniques and primary ingredients. The limited health evidence shows that consumption of plant-based meat analogues tends to be associated with positive health outcomes, while consumption of some plant-based drinks can be linked to micronutrient deficiencies. Fortified PBAs can contribute to daily recommended intakes and sometimes provide more micronutrients than their animal-based counterparts, while also providing more fibre, and less energy and saturated fat. Despite these potential benefits, debates persist around processing classifications and their health implications. Given this complex landscape, assessing what kind of role PBAs could play in our food systems will demand product-specific evaluation, targeted dietary recommendations, and expanding the range of healthier PBAs. To advance the field and accelerate dietary shifts without unintended consequences, critical considerations include strengthening the nutritional evidence-base, classifying PBAs further for dietary recommendations and informed regulatory approaches, understanding processing effects and use of additives, and standardising environmental outcomes and research beyond single ingredients.
The Spanish agricultural sector depends on seasonal agricultural migrant workers. This study aimed to examine the associations among dietary patterns, sociodemographic factors, and food security among seasonal agricultural workers.
Design:
A cross-sectional multicentre study. The dietary pattern was evaluated according to the Spanish Society of Community Nutrition recommendations for the adult population. Descriptive analysis was disaggregated according to sex. Multi-adjusted logistic models were used to assess the association between dietary patterns and explanatory variables.
Setting:
Work sites and temporary accommodations in 4 Spanish provinces: North Spain: Lleida and La Rioja, and South Spain: Almeria and Huelva.
Participants:
Male and Female Seasonal Agricultural Migrant Workers (n=623).
Results:
The final sample consisted of 609 migrant agricultural workers. Of these, 36% were female, and 61% were classified as North African. Overall, 40% of the participants adhered to the evaluated dietary pattern. Adherence was positively associated with North African nationality, being married or cohabiting, and low socio-economic status. Not skipping meals due to economic constraints and receiving food aid emerged as key factors contributing to greater adherence to the assessed dietary pattern.
Conclusions:
This study provides an initial insight into the dietary pattern of seasonal agricultural migrant workers in Spain. The findings indicate that external socioeconomic and structural factors primarily shape their dietary habits. Policies aimed at enhancing food security and other food coping strategies, such as access to food aid, are crucial for improving dietary adherence to a healthy dietary pattern.
To test the ‘Investigate Exposure’ step of the WHO’s CLICK framework, and to investigate 12–16-year-old children’s exposure to paid-for digital food advertising in Finland.
Design:
The DIGITUTKA pilot study was carried out as part of the EU Joint Action Best-ReMap project. Data on paid-for digital food advertising that children were exposed to via their phones over a two-weeks period were captured using the RealityMeter-application, following the ‘Investigate Exposure’ step of the CLICK framework. Data were collected between April and June 2022 and analyzed in Excel, following a protocol outlined by WHO Europe. The WHO Europe Nutrient Profile Model (v1, 2015) was used to determine marketing permission.
Setting:
Four schools in Finland
Participants:
6th-9th grade students (n=34)
Results:
Out of the 17 820 captured advertisements, 2316 (13%) were identified as food or beverage brands and products. The most commonly advertised products were convenience foods, composite dishes (16%, N=372), and energy drinks (9%, N=202). The majority of the food and beverage advertisements (N=1291, 56%) were not permitted to be marketed to children, with only one in ten (N=222, 9%) was permitted to be marketed to children. A third (35%) of the food and beverage advertisements could not be identified due to missing information.
Conclusions:
Children were exposed to a large number of food and beverage advertisements, most of which were not permitted to be marketed to children. To protect children’s health and prevent obesity, marketing restrictions should be combined with broader changes to the food environment and taxation.
This review aims to explore the potential role of folate and related B-vitamins (B12, B6, and riboflavin) in maintaining cognitive health in ageing, focussing particularly on their interactions with the gut microbiota and inflammation. Low B-vitamin status, common in older adults, is associated with poorer cognitive function and dementia. Furthermore, people with dementia are observed to have increased abundance of pro-inflammatory microbes and concomitant higher concentrations of cytokines in their circulation. Therefore, gut dysbiosis and chronic inflammation have been proposed as contributors of cognitive dysfunction. Although many observational studies report that low B-vitamin status, especially vitamin B6, is associated with a worse inflammatory state, the role of the gut microbiota is much less investigated. Pre-clinical evidence suggests higher B-vitamin intakes may beneficially modulate the gut bacterial profile and its metabolic activity, positively influencing inflammation. The evidence however is inconsistent and the few human intervention studies available are confined to clinical populations, or are limited by small sample size or to a single B-vitamin at high supplementation doses. Of note, one study in rats with Alzheimer’s type dementia reported an association of folate and vitamin B12 deficiency with disturbed gut bacterial composition, neuroinflammation and impaired memory. In conclusion, optimising B-vitamin status may help promote cognitive health during ageing through modulation of the gut microbiota and immune function. Well-designed human studies are however required to confirm these relationships and inform evidence-based nutritional strategies for healthy ageing.
Newfoundland and Labrador (NL) introduced Canada’s first excise tax on sugar-sweetened beverages (SSBs) in 2022. Industry marketing practices in response to SSB taxation may affect public health impacts. We examined changes in posted beverage pricing and marketing of taxable and non-taxable beverages in NL before and after the SSB tax was implemented.
Design:
Pre-/post- observational study with in-store audits of beverage prices and marketing. Changes including pricing discounts and promotions were assessed the at the individual beverage level, for years pre/post-tax implementation.
Setting:
80 food stores (grocery, convenience, drug, dollar) in NL, Canada.
Results:
There was no evidence of a change in posted shelf prices between pre/post years. There was a significant increase (+2.5%, χ2=9.693, p=0.002) in proportion of discounted taxable SSBs with no change in non-taxable beverages (p=0.350). There were no significant differences in change of number of promotions for taxable SSBs (+5.2 [-0.1, 10.5], F=3.789, p=0.053) nor non-taxable beverages (+3.4 [-1.0, 7.7], F=2.268, p=0.134).
Conclusions:
The lack of change in posted prices of taxable SSBs indicate that the NL SSB tax was not communicated at the point of decision-making. While some marketing changes post-tax were observed, results should be interpreted cautiously as they cannot be attributed definitively to the tax. Existing literature implies that industry may adapt marketing conduct to counteract beverage taxes. Such changes were limited in NL, suggesting retailers may have opted not to display the tax rather than attempt to actively counteract it. Lack of transparency surrounding the tax may neutralize intended behavioral effects.
Vitamin A deficiency (VAD) is common among pregnant women (PW) and has been associated with anaemia and adverse birth outcomes. However, in the Free State Province of South Africa, evidence regarding this is limited. Hence, this cross-sectional study investigated the vitA intake and status of PW in Bloemfontein and its association with anaemia, iron status and birth outcomes. Blood was taken from 427 PW to assess status of vitA (retinol-binding protein 4 (RBP4)), iron (ferritin, soluble transferrin receptor), and anaemia (haemoglobin (Hb)). Sociodemographic, HIV, birth outcomes (birth weight and gestational age), and dietary vitA intake data were obtained using a questionnaire in an interview and medical records. Descriptive statistics and linear regression were used to describe variables and association between vitA and iron status and birth outcomes. Median vitA intake was 1007µgRAE/d, with 19% of participants’ intake below the EAR of 550µg/d. Median (IQR) RBP4 concentration was 1.51 (0.78) µmol/L. Insufficient vitA and VAD prevalence was 12.2% and 1.2%, respectively. VitA intake was positively associated with RBP4 (β=0.068; 95%CI: 0.020, 0.116; p=0.006). RBP4 was positively associated with Hb (β=0.363; 95%CI: 0.186, 0.539; p <0.001) and ferritin (β=0.359; 95%CI: 0.139, 0.579; p=0.001) but negatively with sTfR (β=-0.125; 95%CI: -0.246, -0.005, p=0.041). No significant association between plasma RBP4 and birth weight, as well as preterm birth was observed. There was a low prevalence of VAD in the study population. Nonetheless, the positive association between RBP4 and Hb, and ferritin highlights the importance of optimal vitA status in preventing maternal anaemia in pregnancy.
This study investigated changes in serum folate and B12, and associations with endurance performance and bone outcomes, in women during military training. Women (n = 137) had serum folate and B12, haematological markers, and endurance performance (2.4 km run) measured at the start (week 1) and end (week 13) of British Army basic training. Whole-body areal bone mineral density and markers of bone metabolism were measured at week 1. Training decreased serum folate (mean change [95% CI], −2.3 [−3.0, −1.6] nmol∙L-1, p < 0.001), B12 (−16 [−32, 0] pmol∙L-1, p = 0.042), haemoglobin (−0.7 [−0.9, −0.5] g∙dL-1, p < 0.001), and red blood cell (RBC) count (−0.2 [−0.3, −0.2] × 10^9∙L-1, p < 0.001), but had no effect on mean corpuscular volume (p = 0.438) or erythrocyte distribution width (p = 0.088). There was no association between serum folate, serum B12, haemoglobin, or RBC count with run time (p ≥ 0.518). Serum B12 was not associated with areal bone mineral density or bone metabolism at week 1 (p ≥ 0.152). Higher serum folate was associated with lower plasma c-telopeptide cross-links of type I collagen (standardised β [95% CI] = −0.31 [−0.48, −0.15], p < 0.001), but not whole-body bone mineral density or plasma procollagen type I N-terminal propeptide (p ≥ 0.152). Serum folate and B12 decreased after military training in women, resulting in a high prevalence of folate deficiencies at the end of training. Low serum folate may contribute to increased bone resorption, the implications of which are unclear.
The objective of this study was to develop, implement, and refine a food environment survey to capture people’s perceptions of their food environments in low-and middle-income countries: the Food Environment Perceptions Survey (FEPS).
Design:
Identifying aspects of food environment to include: drawing from existing survey instruments; a Delphi survey with food environment experts working globally; workshops with local experts in India and Cambodia; cognitive testing of the survey items; and piloting the tools in diverse field settings in India and Cambodia.
Setting:
Rural, peri-urban, and urban communities in India and Cambodia.
Participants:
Global food environment experts for Delphi survey; food environment experts in India and Cambodia for workshops; convenience sample of participants in India (n=44) and Cambodia (n=60) for FEPS piloting.
Results:
The FEPS underwent many iterations prior to piloting. The initial versions of the survey were long, leading us to remove questions and reconfigure the survey to streamline it. The workshop participants rated the revised survey versions relatively favorably. The final survey consists of 109 questions covering six sections: accessibility and availability (48 questions); affordability (5 questions), convenience (17 questions); quality and safety (3 questions); information, promotion, and labeling (16 questions); and an optional sustainability section (20 questions). Based on pilot data, we found significant differences in how participants interacted with different food environment types across rural, peri-urban, and urban transects.
Conclusions:
The finalized FEPS is a newly developed survey instrument that can be incorporated by other researchers to characterize diverse perceptions of food environments in LMICs.
Genetic predisposition to obesity can stimulate an increase in adiposity throughout adulthood. However, the interaction between genetic factors and dietary habits may modify the genetic association with obesity. Thus, this study aimed to investigate the dietary patterns that influence the genetic risk of obesity in a Korean population using a large cohort study and genome-wide association study.
Design:
Prospective cohort study.
Setting:
The genetic risk score (GRS) was calculated based on six identified single nucleotide polymorphisms of the OTOL1, NMBR, DNAJB9, ASCC1, NT5C2, and FTO genes associated with obesity, as ascertained by body mass index. Dietary patterns were determined using food intake data from a food frequency questionnaire and factor analysis.
Participants:
This study included data from 8,458 adults aged 40-69 years from the Ansan and Ansung cohorts of the Korean Genome and Epidemiology Study.
Results:
The refined carbohydrate dietary pattern showed a significant inverse association with obesity in the highest GRS group with a non-significant interactive association (odds ratio [OR], 0.801; 95% confidence interval [CI], 0.662–‒0.969; P for trend = 0.0251, P for interaction = 0.571). However, participants with the highest refined carbohydrate dietary pattern score and highest GRS had an increased prevalence of obesity (OR: 1.288, 95% CI: 1.068‒1.554, P for trend = 0.0251) compared with the prevalence of those with the lowest dietary pattern score and GRS.
Conclusions:
Reducing refined carbohydrate consumption may be helpful for Korean adults with a greater genetic susceptibility to obesity.
Previous estimations of the associations between fruits and vegetables intake with diabetes markers showed mixed results, possibly partly because of the subjective assessment of dietary intake. We aimed to examine the relationship between the biomarkers (plasma carotenoids and α-tocopherol) as objective markers of fruit and vegetables (F/V) intake and fasting glucose in adults. This was a population-based cross-sectional study in 592 adults in Cameroon. Self-reported F/V intake was assessed using the WHO STEPS questionnaire and the biomarkers were analysed by high-performance liquid chromatography coupled with a photodiode array detector. The mean age of participants was 38.5±8.6 years (63.7% women). The median (IQR) number of times participants self-reported consuming fruits in a typical week was 2(1-5) times/week and vegetables was 4(2-7) times/week. Plasma total carotenoids was positively correlated with self-reported intake of fruits (r=0.13) and vegetables (r = 0.29), both p-value < 0.01. In unadjusted analysis, the difference in fasting glucose comparing the highest against the lowest tertile of the biomarkers concentrations was -0.28(95% CI -0.56 to -0.001) mmol/L for total carotenoids and -0.31(-0.59 to -0.03) mmol/L for plasma α-carotene. The inverse associations became stronger after adjusting for socio-demographics, smoking status, alcohol intake, season, physical activity, BMI and total cholesterol (-0.36(-0.73 to -0.002) mmol/L for total carotenoids and -0.41(-0.79 to -0.03) mmol/L for α-carotene). There was no evidence of an association between α-tocopherol and fasting glucose. We showed an inverse association of total carotenoids and α-carotene, objective indicators of F/V intake with fasting glucose. This suggests that a higher intake of F/V could be beneficial for diabetes prevention in African populations in whom the intake of F/V is low.
We applied an innovative agent-based modeling (ABM) approach to investigate how and to what extent spillover effects occur beyond dietary interventions.
Design:
We developed an agent-based-model (ABM) in NetLogo to simulate the dietary practices of the Dutch adult population during lunch and dinner, representing participants in the Dutch National Food Consumption Survey.
Setting:
The model assessed spillover effects beyond a hypothetical workplace canteen intervention targeting increased plant-based protein consumption during lunch. Direct effects were defined as the percentage of non-vegetarian employees consuming a vegetarian lunch. Spillover effects were indicated by the percentage of plant-based protein consumed at dinner, influenced by dietary identity, habituation, social networks, and eating location. Scenarios with varying direct effect sizes were simulated to compare plant-based protein consumption at dinner.
Results:
Simulations demonstrated a positive spillover effect at the population level, with plant-based protein consumption at dinner increasing over three years compared to baseline (no intervention). At direct intervention effect sizes up to 0.5, there was a linear increase in plant-based protein consumption at dinner (from 23.0% [95%CI 22.9–23.2] at baseline to 32.3% [95%CI 31.8–32.8]). Spillover effects plateaued beyond an effect size of 0.5, with no significant further increases observed.
Conclusions:
Our application of ABM revealed that positive spillover effects of dietary interventions from workplace to home can be achieved. Despite challenges, ABM might complement other approaches for studying spillover effects and supporting dietary behavior change towards more sustainable diets.