Sara Monteiro Pires

Background: Comparing the health impacts of sustainable dietary patterns is challenging due to varying definitions and assessment methods across studies. We aimed to identify, summarise, and discuss these definitions and identify their associated quantitative health impacts. Methods: The search was conducted in PubMed, Web of Science, and Scopus on November 24th, 2023. Papers published since 1986, that focused on general human populations, defined sustainable dietary patterns, and quantified associated health impacts were included. Results: We identified 10,051 unique studies of which 97 were included. Most studies were conducted only in high-income countries (80%) and nearly 80% were published after 2019. About half of the included studies used predictive modelling to estimate health impacts (44%) and among these, most risk-outcome data came from Global Burden of Disease studies (44%). The EAT-Lancet planetary health diet emerged as the most common dietary pattern definition (29%). Conclusions: Our review highlights a lack of consistency in sustainable dietary pattern definitions and a stark geographical disparity in investigations connecting sustainable eating to health outcomes. Along with the lack of standard epidemiological data sources for predictive health impact modelling, these findings complicate cross-study comparisons and underscore the need for harmonised definitions and standard data sources to better understand the implications of sustainable diets globally. Trial registration: Open Science Framework— https://doi.org/10.17605/OSF.IO/AJN3Y

Inorganic arsenic (iAs) is a naturally occurring carcinogen found in food and water, with dietary intake being a primary route of exposure. Socioeconomic status (SES) influences chemical exposure patterns, yet its role in the environmental burden of disease (EBD) remains underexplored. This study estimated the disease burden of bladder, lung and skin cancer attributable to dietary iAs in Belgium, Denmark and Portugal, using education (low, medium, high) as a proxy for SES. National food consumption surveys and country-specific iAs occurrence data were combined with exposure-response functions and national health and demographic data to calculate attributable incidence and disability-adjusted life years (DALYs).Across all education groups, the Portuguese populations showed the highest dietary iAs exposure (mean: 0.267–0.460 µg/kg bodyweight/day), whereas Danish and Belgian populations had lower, comparable exposures (0.114–0.153 and 0.084–0.102 µg/kg bw/day, respectively) that fell within the European range (0.03–0.15 µg/kg bw/day) reported by EFSA. All three populations’ intakes surpassed the EFSA Reference Point of 0.06 µg/kg bw/day by 1.5–6 fold.The attributable burden rate of dietary iAs, expressed as DALYs per 100,000 individuals, was highest in Portugal (13.4), followed by Denmark (3.86) and Belgium (2.59), with higher education groups consistently showing higher burdens. Lung cancer contributed most to DALYs due to higher severity and mortality, while skin cancer contributed relatively little despite higher incidence. These findings highlight SES-related differences in DALYs and underscore the importance of integrating socioeconomic factors like education, income in dietary risk assessments and cross-country burden comparisons.