Skip to main content

Operationalising the health aspects of sustainable diets: a review

  • Elly Mertens (a1), Pieter van’t Veer (a1), Gerrit J Hiddink (a2) (a3), Jan MJM Steijns (a4) and Anneleen Kuijsten (a1)...

Shifting towards a more sustainable food consumption pattern is an important strategy to mitigate climate change. In the past decade, various studies have optimised environmentally sustainable diets using different methodological approaches. The aim of the present review was to categorise and summarise the different approaches to operationalise the health aspects of environmentally sustainable diets.


Conventional keyword and reference searches were conducted in PubMed, Scopus, Web of Knowledge and CAB Abstracts. Inclusion criteria were: (i) English-language publication; (ii) published between 2005 and October 2015; (iii) dietary data collected for the diet as a whole at the national, household or individual level; (iv) comparison of the current diet with dietary scenarios; and (v) for results to consider the health aspect in some way.


Consumer diets.


Adult population.


We reviewed forty-nine studies that combined the health and environmental aspects of consumer diets. Hereby, five approaches to operationalise the health aspect of the diet were identified: (i) food item replacements; (ii) dietary guidelines; (iii) dietary quality scores; (iv) diet modelling techniques; and (v) diet-related health impact analysis.


Although the sustainability concept is increasingly popular and widely advocated by nutritional and environmental scientists, the journey towards designing sustainable diets for consumers has only just begun. In the context of operationalising the health aspects, diet modelling might be considered the preferred approach since it captures the complexity of the diet as a whole. For the future, we propose SHARP diets: environmentally Sustainable (S), Healthy (H), Affordable (A), Reliable (R) and Preferred from the consumer’s perspective (P).

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Operationalising the health aspects of sustainable diets: a review
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Operationalising the health aspects of sustainable diets: a review
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Operationalising the health aspects of sustainable diets: a review
      Available formats
Corresponding author
* Corresponding author: Email
Hide All
1. Tilman, D, Balzer, C, Hill, J et al. (2011) Global food demand and the sustainable intensification of agriculture. Proc Natl Acad Sci U S A 108, 2026020264.
2. Vermeulen, SJ, Campbell, BM & Ingram, JSI (2012) Climate change and food systems. Annu Rev Environ Resour 37, 195222.
3. Alexandratos, N & Bruinsma, J (2012) World Agriculture Towards 2030/2050: The 2012 Revision. ESA Working Paper no. 12-03. Rome: FAO.
4. Godfray, H, Beddington, J, Crute, I et al. (2010) Food security: the challenge of feeding 9 billion people. Science 327, 812818.
5. Maynard, LA (1959) An adequate diet. J Am Med Assoc 170, 457458.
6. World Health Organization (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Joint WHO/FAO Expert Consultation. WHO Technical Report Series no. 916. Geneva: WHO.
7. Garnett, T (2011) Where are the best opportunities for reducing greenhouse gas emissions in the food system (including the food chain)? Food Policy 36, Suppl. 1, S23S32.
8. Hallström, E, Carlsson-Kanyama, A & Börjesson, P (2015) Environmental impact of dietary change: a systematic review. J Clean Prod 91, 111.
9. Craig, WJ & Mangels, AR (2009) Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 109, 12661282.
10. Burlingame, B & Dernini, S (editors) (2012) Sustainable Diets and Biodiversity: Directions and Solutions for Policy, Research and Action. Proceedings of the International Scientific Symposium Biodiversity and Sustainable Diets United Against Hunger, 3–5 November 2010, FAO Headquarters, Rome. Rome: FAO.
11. United Nations Environment Programme. (2012) Avoiding Future Famines: Strengthening the Ecological Foundation of Food Security through Sustainable Food Systems. A UNEP Synthesis Report. Nairobi: UNEP.
12. Eshel, G & Martin, PA (2006) Diet, energy, and global warming. Earth Interact 10, 117.
13. Baroni, L, Cenci, L, Tettamanti, M et al. (2007) Evaluating the environmental impact of various dietary patterns combined with different food production systems. Eur J Clin Nutr 61, 279286.
14. Stehfest, E, Bouwman, L, van Vuuren, D et al. (2009) Climate benefits of changing diet. Clim Chang 95, 83102.
15. Westhoek, H, Lesschen, JP, Rood, T et al. (2014) Food choices, health and environment: effects of cutting Europe’s meat and dairy intake. Glob Environ Chang 26, 196205.
16. Gerbens-Leenes, W & Nonhebel, S (2005) Food and land use. The influence of consumption patterns on the use of agricultural resources. Appetite 45, 2431.
17. Buzby, J, Wells, H & Vocke, G (2006) Possible Implications for US Agriculture from Adoption of Select Dietary Guidelines. Economic Research Report no. ERR-31. Washington, DC: US Department of Agriculture, Economic Research Service.
18. Tukker, A, Goldbohm, RA, de Koning, A et al. (2011) Environmental impacts of changes to healthier diets in Europe. Ecol Econ 70, 17761788.
19. Wolf, O, Pérez-Domínguez, I, Rueda-Cantuche, JM et al. (2011) Do healthy diets in Europe matter to the environment? A quantitative analysis. J Policy Model 33, 828.
20. Capone, R, Iannetta, M, Bilali, HE et al. (2013) A preliminary assessment of the environmental sustainability of the current Italian dietary pattern: water footprint related to food consumption. J Food Nutr Res 1, 5967.
21. Sáez-Almendros, S, Obrador, B, Bach-Faig, A et al. (2013) Environmental footprints of Mediterranean versus Western dietary patterns: beyond the health benefits of the Mediterranean diet. Environ Health 12, 118.
22. Saxe, H, Larsen, TM & Mogensen, L (2013) The global warming potential of two healthy Nordic diets compared with the average Danish diet. Clim Chang 116, 249262.
23. Vanham, D (2013) The water footprint of Austria for different diets. Water Sci Technol 67, 824830.
24. Vanham, D, Mekonnen, MM & Hoekstra, AY (2013) The water footprint of the EU for different diets. Ecol Indic 32, 18.
25. Heller, MC & Keoleian, GA (2014) Greenhouse gas emissions of the US diet: aligning nutritional recommendations with environmental concerns. In Proceedings of the 9th International Conference on Life Cycle Analysis in the Agri-Food Sector (LCA Food 2014), 8–10 October, San Francisco, USA, pp. 539–548 [R Schenck and D Huizenga, editors]. Vashon, WA: American Center for Life Cycle Assessment.
26. Heller, MC & Keoleian, GA (2014) Greenhouse gas emission estimates of US dietary choices and food loss. J Ind Ecol 19, 391401.
27. Jalava, M, Kummu, M, Porkka, M et al. (2014) Diet change – a solution to reduce water use? Environ Res Lett 9, 074016.
28. Collins, A & Fairchild, R (2007) Sustainable food consumption at a sub-national level: an ecological footprint, nutritional and economic analysis. J Environ Policy Plan 9, 530.
29. Friel, S, Barosh, LJ & Lawrence, M (2013) Towards healthy and sustainable food consumption: an Australian case study. Public Health Nutr 17, 11561166.
30. Pairotti, MB, Cerutti, AK, Martini, F et al. (2015) Energy consumption and GHG emission of the Mediterranean diet: a systemic assessment using a hybrid LCA–IO method. J Clean Prod 103, 507516.
31. Scarborough, P, Allender, S, Clarke, D et al. (2012) Modelling the health impact of environmentally sustainable dietary scenarios in the UK. Eur J Clin Nutr 66, 710715.
32. Briggs, A, Kehlbacher, A, Tiffin, R et al. (2013) Assessing the impact on chronic disease of incorporating the societal cost of greenhouse gases into the price of food: an econometric and comparative risk assessment modelling study. BMJ Open 3, e003543.
33. Berners-Lee, M, Hoolohan, C, Cammack, H et al. (2012) The relative greenhouse gas impacts of realistic dietary choices. Energy Policy 43, 184190.
34. Hoolohan, C, Berners-Lee, M, McKinstry-West, J et al. (2013) Mitigating the greenhouse gas emissions embodied in food through realistic consumer choices. Energy Policy 63, 10651074.
35. Vieux, F, Darmon, N, Touazi, D et al. (2012) Greenhouse gas emissions of self-selected individual diets in France: changing the diet structure or consuming less? Ecol Econ 75, 91101.
36. Werner, LB, Flysjo, A & Tholstrup, T (2014) Greenhouse gas emissions of realistic dietary choices in Denmark: the carbon footprint and nutritional value of dairy products. Food Nutr Res 2014, 58.
37. Vieux, F, Soler, LG, Touazi, D et al. (2013) High nutritional quality is not associated with low greenhouse gas emissions in self-selected diets of French adults. Am J Clin Nutr 97, 569583.
38. Masset, G, Vieux, F, Verger, EO et al. (2014) Reducing energy intake and energy density for a sustainable diet: a study based on self-selected diets in French adults. Am J Clin Nutr 99, 14601469.
39. Roos, E, Karlsson, H, Witthoft, C et al. (2015) Evaluating the sustainability of diets – combining environmental and nutritional aspects. Environ Sci Policy 47, 157166.
40. van Dooren, C, Marinussen, M, Blonk, H et al. (2014) Exploring dietary guidelines based on ecological and nutritional values: a comparison of six dietary patterns. Food Policy 44, 3646.
41. Van Dooren, C & Aiking, H (2014) Defining a nutritionally healthy, environmentally friendly, and culturally acceptable Low Lands Diet. In Proceedings of the 9th International Conference on Life Cycle Analysis in the Agri-Food Sector (LCA Food 2014), 8–10 October, San Francisco, USA, pp. 1427–1438 [R Schenck and D Huizenga, editors]. Vashon, WA: American Center for Life Cycle Assessment.
42. Germani, A, Vitiello, V, Giusti, AM et al. (2014) Environmental and economic sustainability of the Mediterranean Diet. Int J Food Sci Nutr 65, 10081012.
43. Arnoult, MH, Jones, PJ, Tranter, RB et al. (2010) Modelling the likely impact of healthy eating guidelines on agricultural production and land use in England and Wales. Land Use Policy 27, 10461055.
44. Macdiarmid, JI, Kyle, J, Horgan, GW et al. (2012) Sustainable diets for the future: can we contribute to reducing greenhouse gas emissions by eating a healthy diet? Am J Clin Nutr 96, 632639.
45. Thompson, S, Gower, R, Darmon, N et al. (2013) A Balance of Healthy and Sustainable Food Choices for France, Spain and Sweden. Godalming: WWF-UK.
46. Green, R, Milner, J, Dangour, AD et al. (2015) The potential to reduce greenhouse gas emissions in the UK through healthy and realistic dietary change. Clim Change 129, 253265.
47. Aston, LM, Smith, JN & Powles, JW (2012) Impact of a reduced red and processed meat dietary pattern on disease risks and greenhouse gas emissions in the UK: a modelling study. BMJ Open 2, e001072.
48. Milner, J, Green, R, Dangour, AD et al. (2015) Health effects of adopting low greenhouse gas emission diets in the UK. BMJ Open 5, e007364.
49. Friel, S, Dangour, AD, Garnett, T et al. (2009) Public health benefits of strategies to reduce greenhouse-gas emissions: food and agriculture. Lancet 374, 20162025.
50. Temme, EH, van der Voet, H, Thissen, JT et al. (2013) Replacement of meat and dairy by plant-derived foods: estimated effects on land use, iron and SFA intakes in young Dutch adult females. Public Health Nutr 16, 19001907.
51. Carvalho, AMd, César, CLG, Fisberg, RM et al. (2013) Excessive meat consumption in Brazil: diet quality and environmental impacts. Public Health Nutr 16, 18931899.
52. Tyszler, M, Kramer, G & Blonk, H (2014) Just eating healthier is not enough: studying the environmental impact of different diet scenarios for the Netherlands by linear programming. In Proceedings of the 9th International Conference on Life Cycle Analysis in the Agri-Food Sector (LCA Food 2014), 8–10 October, San Francisco, USA, pp. 1367–1376 [R Schenck and D Huizenga, editors]. Vashon, WA: American Center for Life Cycle Assessment.
53. van Dooren, C, Tyszler, M, Kramer, G et al. (2015) Combining low price, low climate impact and high nutritional value in one shopping basket through diet optimization by Linear Programming. Sustainability 7, 12837.
54. Temme, EH, Toxopeus, IB, Kramer, GF et al. (2015) Greenhouse gas emission of diets in the Netherlands and associations with food, energy and macronutrient intakes. Public Health Nutr 18, 24332445.
55. Hendrie, GA, Ridoutt, BG, Wiedmann, TO et al. (2014) Greenhouse gas emissions and the Australian Diet – comparing dietary recommendations with average intakes. Nutrients 6, 289303.
56. Wilson, N, Nghiem, N, Mhurchu, C et al. (2013) Foods and dietary patterns that are healthy, low-cost, and environmentally sustainable: a case study of optimization modeling for New Zealand. PLoS One 8, e59648.
57. Monsivais, P, Scarborough, P, Lloyd, T et al. (2015) Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom. Am J Clin Nutr 102, 138145.
58. Meier, T & Christen, O (2013) Environmental impacts of dietary recommendations and dietary styles: Germany as an example. Environ Sci Technol 47, 877888.
59. Meier, T, Christen, O, Semler, E et al. (2014) Balancing virtual land imports by a shift in the diet. Using a land balance approach to assess the sustainability of food consumption. Germany as an example. Appetite 74, 2034.
60. Biesbroek, S, Bueno-de-Mesquita, H, Peeters, P et al. (2014) Reducing our environmental footprint and improving our health: greenhouse gas emission and land use of usual diet and mortality in EPIC-NL: a prospective cohort study. Environ Health 13, 27.
61. de Bakker, E & Dagevos, H (2012) Reducing meat consumption in today’s consumer society: questioning the citizen–consumer gap. J Agric Environ Ethics 25, 877894.
62. de Boer, J, Schösler, H & Aiking, H (2014) ‘Meatless days’ or ‘less but better’? Exploring strategies to adapt Western meat consumption to health and sustainability challenges. Appetite 76, 120128.
63. Verain, MC, Dagevos, H & Antonides, G (2015) Sustainable food consumption. Product choice or curtailment? Appetite 91, 375384.
64. World Health Organization (2010) World Health Statistics 2010. Geneva: WHO.
65. Mensink, GB, Fletcher, R, Gurinovic, M et al. (2013) Mapping low intake of micronutrients across Europe. Br J Nutr 110, 755773.
66. Health Council of the Netherlands (2011) Guidelines for a Healthy Diet: The Ecological Perspective. The Hague: Health Council of the Netherlands.
67. Reynolds, CJ, Buckley, JD, Weinstein, P et al. (2014) Are the dietary guidelines for meat, fat, fruit and vegetable consumption appropriate for environmental sustainability? A review of the literature. Nutrients 6, 22512265.
68. Hutton, T (2002) Sodium technological functions of salt in the manufacturing of food and drink products. Br Food J 104, 126152.
69. Wirt, A & Collins, CE (2009) Diet quality – what is it and does it matter? Public Health Nutr 12, 24732492.
70. Drewnowski, A & Fulgoni, V 3rd (2008) Nutrient profiling of foods: creating a nutrient-rich food index. Nutr Rev 66, 2339.
71. Van Kernebeek, HRJ, Oosting, SJ, Feskens, EJM et al. (2014) The effect of nutritional quality on comparing environmental impacts of human diets. J Clean Prod 73, 8899.
72. Macdiarmid, J, Kyle, J, Horgan, G et al. (2011) Livewell: A Balance of Healthy and Sustainable Food Choices. Godalming: WWF-UK.
73. Roininen, K, Lähteenmäki, L & Tuorila, H (1999) Quantification of consumer attitudes to health and hedonic characteristics of foods. Appetite 33, 7188.
74. Verbeke, W (2008) Impact of communication on consumers’ food choices. Proc Nutr Soc 67, 281288.
75. Grunert, KG, Hieke, S & Wills, J (2014) Sustainability labels on food products: consumer motivation, understanding and use. Food Policy 44, 177189.
76. Coff, C, Korthals, M & Barling, D (2008) Ethical traceability and informed food choice. In Ethical Traceability and Communicating Food, pp. 118 [C Coff, D Barling, M Korthals et al., editors]. Dordrecht: Springer.
77. Oosterveer, P & Sonnenfeld, DA (2012) Food, Globalization and Sustainability . Abingdon: Routledge.
78. Food and Agriculture Organization of the United Nations (2016) Supply Utilization Accounts and Food Balance Sheets – background information for your better understanding. (accessed January 2016).
79. Trichopoulou, A (1992) Monitoring food intake in Europe: a food data bank based on household budget surveys. Eur J Clin Nutr 46, Suppl. 5, S3S8.
80. Thompson, FE, Subar, AF, Coulston, A et al. (2008) Dietary assessment methodology. In Nutrition in the Prevention and Treatment of Disease, 2nd ed., pp. 339 [AM Coulston and CJ Boushey, editors]. San Diego, CA: Academic Press.
81. Herforth, A, Frongillo, EA, Sassi, F et al. (2014) Toward an integrated approach to nutritional quality, environmental sustainability, and economic viability: research and measurement gaps. Ann N Y Acad Sci 1332, 121.
82. European Food Safety Authority, Panel on Dietetic Products, Nutrition and Allergies (2010) Scientific Opinion on principles for deriving and applying Dietary Reference Values. EFSA J 8, 1458.
83. World Health Organization (2003) Food-based Dietary Guidelines in the WHO European Region. Copenhagen: WHO Regional Office for Europe.
84. Backstrand, JR (2003) Quantitative approaches to nutrient density for public health nutrition. Public Health Nutr 6, 829837.
85. Finnveden, G, Hauschild, MZ, Ekvall, T et al. (2009) Recent developments in life cycle assessment. J Environ Manage 91, 121.
86. Lock, K, Smith, RD, Dangour, AD et al. (2010) Health, agricultural, and economic effects of adoption of healthy diet recommendations. Lancet 376, 16991709.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed